title: Successful treatment of a mycotic aortic pseudoaneurysm in a patient with type 2 diabetes mellitus while treating primary aldosteronism with spironolactone.
abstract: We describe a diabetic patient successfully treated for an acute mycotic aortic arch pseudoaneurysm with primary aldosteronism. The patient first complained of severe pain in the left upper extremity and left back with high C reactive protein (CRP) and high-grade fever. It was suspected that acute aortic dissection had developed in association with mycotic pseudoaneurysm of the aortic arch because of chest X-ray findings of enlargement of the aortic arch. Computed tomography (CT) of the aortic arch revealed an aortic aneurysm protruding in the superior direction. Staphylococcus aureus was detected in blood culture, suggesting a mycotic aortic aneurysm, and artificial blood vessel replacement of the aortic arch was performed. Intraoperative findings suggested aortic pseudoaneurysm, which consisted of mediastinal rupture of the aorta at the distal arch. Our patient had a 2-year history of type 2 diabetes mellitus and poor blood sugar control, even with twice-daily injection of insulin. Blood pressure was not always well controlled because of primary aldosteronism. Thus, it was speculated that hyperaldosteronism, as well as diabetes-associated atherosclerosis, had persisted for a long time. No reports have described mycotic pseudoaneurysm in the aortic arch in a diabetic patient associated with primary aldosteronism. It is necessary to note that serious vascular complications are possible if aldosteronism is left untreated or is treated insufficiently as essential hypertension.
authors.affiliation: Division of Endocrinology & Metabolism. Department of Medicine, Yokohama Rosai Hospital, 3211 Kozukue-cho, Kohoko-ku, Yokohama City, Japan.
authors.forename: Yuzuru
authors.initials: Y
authors.lastname: Ito
authors.forename: Koichiro
authors.initials: K
authors.lastname: Yoshimura
authors.forename: Yoko
authors.initials: Y
authors.lastname: Matsuzawa
authors.forename: Jun
authors.initials: J
authors.lastname: Saito
authors.forename: Hiroko
authors.initials: H
authors.lastname: Ito
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Furukawa
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Okura
authors.forename: Mutsumu
authors.initials: M
authors.lastname: Fukata
authors.forename: Toshio
authors.initials: T
authors.lastname: Konishi
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Nishikawa
mesh_terms: D000368:Aged; D017541:Aneurysm, False / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D000785:Aneurysm, Infected / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D001014:Aortic Aneurysm / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D019917:Blood Vessel Prosthesis Implantation; D048909:Diabetes Complications / Q000473:pathology / Q000628:therapy; D003924:Diabetes Mellitus, Type 2 / Q000188:drug therapy* / Q000382:microbiology; D005260:Female; D006801:Humans; D006929:Hyperaldosteronism / Q000188:drug therapy* / Q000382:microbiology; D013148:Spironolactone / Q000009:adverse effects*; D013203:Staphylococcal Infections / Q000209:etiology / Q000473:pathology / Q000628:therapy; D013211:Staphylococcus aureus / Q000472:pathogenicity; D016896:Treatment Outcome
chemical_list: D013148:Spironolactone