title: A case of graft infection 10 years after ascending aorta replacement.
abstract: A 52-year-old man was admitted with anemia and slight fever, which he had for the last 2 months. He had undergone replacement of the ascending aorta for acute aortic dissection 10 years previously. Echocardiography demonstrated a flailing thin structure in the anterior wall of the ascending aorta corresponding to the proximal portion of the prosthetic graft. This abnormal echocardiographic finding led us to repeat blood cultivation. We finally detected Enterococcus facium and Staphylococcus epidermidis in his blood sample. We diagnosed this as a graft infection and prepared for surgical re-replacement of the infected graft. While he was waiting for the operation, an infectious aneurysm of a tibialis posterior artery ruptured and an emergency operation was done. Replacement of the infected ascending aorta graft was done thereafter. In surgery, 2-cm-long vegetation was found. It stuck to the graft wall near the former hole used for air removal in the first surgery. The patient recovered fully and left our hospital after 3 months of postoperative antibiotics therapy. This rare case of aortic graft infection long after the original replacement surgery suggests the importance of thorough echocardiographic investigation of prosthetic graft infection as a possible cause of fever of unknown origin.
authors.affiliation: Department of Cardiovascular Medicine, Japanese Red Cross Medical Center, 4-1-22 Hiro-o, Shibuya-ku, Tokyo 150-8935, Japan.
authors.forename: Sakiko
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Kazuyuki
authors.initials: K
authors.lastname: Fukushima
authors.forename: Daigo
authors.initials: D
authors.lastname: Sawaki
authors.forename: Yoshitaka
authors.initials: Y
authors.lastname: Otani
authors.forename: Gaku
authors.initials: G
authors.lastname: Sekita
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeuchi
authors.forename: Hideo
authors.initials: H
authors.lastname: Adachi
authors.forename: Takashi
authors.initials: T
authors.lastname: Ino
authors.forename: Teruhiko
authors.initials: T
authors.lastname: Aoyagi
mesh_terms: D000783:Aneurysm / Q000601:surgery; D000784:Aortic Dissection / Q000601:surgery*; D001014:Aortic Aneurysm / Q000601:surgery*; D019917:Blood Vessel Prosthesis Implantation; D016984:Enterococcus faecium; D005335:Fever of Unknown Origin / Q000209:etiology; D016908:Gram-Positive Bacterial Infections / Q000601:surgery; D006801:Humans; D008297:Male; D008875:Middle Aged; D016459:Prosthesis-Related Infections / Q000150:complications / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery*; D013203:Staphylococcal Infections / Q000601:surgery; D013212:Staphylococcus epidermidis; D016909:Tibial Arteries; D013997:Time Factors; D014463:Ultrasonography