title: Rupture of an extended mycotic aneurysm of the descending thoracic aorta in a multiple myeloma patient undergoing anti-myeloma therapy.
abstract: Infectious complications in patients with multiple myeloma remain the main cause of mortality because of disease-related immunodeficiency. A mycotic aortic aneurysm caused by Burkhoderia cepacia, which has been recognized as nosocomial pathogen in immunocompromised populations, is very rare and only few cases have been reported in the literature. We describe an unusual case of a ruptured mycotic aneurysm of the descending thoracic aorta with a DeBakey IIIb aortic dissection caused by Burkhoderia cepacia in a patient with active multiple myeloma during chemotherapy with anti-myeloma agents. Successful treatment of this mycotic aneurysm included appropriate antibiotic therapy and replacement of the aortic arch and the descending aorta for the extensive debridement of all infected aortas. This was followed by the wrapping of a prosthetic graft with a well-vascularized tissue flap of the greater omentum and of the latissimus dorsi muscle.
authors.affiliation: Department of Cardiovascular Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1, Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan. maru1616@yahoo.co.jp.
authors.forename: Akira
authors.initials: A
authors.lastname: Marumoto
authors.affiliation: Department of Cardiovascular Surgery, National Hospital Organization Osaka Minami Medical Center, 2-1, Kidohigashi, Kawachinagano, Osaka, 586-8521, Japan.
authors.forename: Keiji
authors.initials: K
authors.lastname: Iwata
mesh_terms: D000368:Aged; D000784:Aortic Dissection / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D000785:Aneurysm, Infected / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D000970:Antineoplastic Agents / Q000627:therapeutic use*; D001014:Aortic Aneurysm / Q000601:surgery; D017545:Aortic Aneurysm, Thoracic / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D019121:Burkholderia Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D016956:Burkholderia cepacia / Q000302:isolation & purification*; D005260:Female; D006801:Humans; D021621:Imaging, Three-Dimensional; D008279:Magnetic Resonance Imaging; D009101:Multiple Myeloma / Q000150:complications* / Q000175:diagnosis / Q000188:drug therapy; D049268:Positron-Emission Tomography; D014057:Tomography, X-Ray Computed
chemical_list: D000970:Antineoplastic Agents
keywords: Immunocompromised patient; Multiple myeloma; Mycotic aneurysm