title: Mycotic aneurysm of the thoracic aorta caused by extended-spectrum beta-lactamase-producing Escherichia coli.
abstract: We report a case of successful treatment of a mycotic aneurysm of the thoracic aorta. A 65-year-old man with a dissecting aneurysm presented with urinary tract infection. He had a history of severe liver cirrhosis. Two weeks after admission, he had a high-grade fever and enhanced computed tomography (CT) demonstrated acute expansion of the distal aortic arch aneurysm. Because of the acute aneurysm expansion and elevated inflammatory response, we suspected a mycotic aortic aneurysm with possible impending rupture. Since conventional open chest surgery was considered to carry a high operative risk, the patient was managed with a combination of emergency endovascular treatment and antibiotic chemotherapy. Extended-spectrum beta-lactamase-producing Escherichia coli were identified from blood culture before treatment. After strict antibiotic therapy, the postoperative course was uneventful and the patient remained well 12 months later.
authors.affiliation: Department of Cardiovascular Surgery, Fukui Cardiovascular Center, 2-228 Shinbo, Fukui 910-0833, Japan. ysk@msic.med.osaka-cu.ac.jp
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Takahashi
authors.forename: Yasushi
authors.initials: Y
authors.lastname: Tsutsumi
authors.forename: Osamu
authors.initials: O
authors.lastname: Monta
authors.forename: Hirokazu
authors.initials: H
authors.lastname: Ohashi
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D000785:Aneurysm, Infected / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017545:Aortic Aneurysm, Thoracic / Q000000981:diagnostic imaging / Q000382:microbiology* / Q000628:therapy; D001027:Aortography / Q000379:methods; D019917:Blood Vessel Prosthesis Implantation; D003131:Combined Modality Therapy; D057510:Endovascular Procedures; D004926:Escherichia coli / Q000201:enzymology*; D006801:Humans; D008297:Male; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D001618:beta-Lactamases / Q000378:metabolism*
chemical_list: D000900:Anti-Bacterial Agents; D001618:beta-Lactamases