title: Graft Infection Masquerading as Rheumatologic Disease: a Rare Case of Aortobifemoral Graft Infection Presenting as Hypertrophic Osteoarthropathy.
abstract: BACKGROUND
  Prosthetic vascular graft procedures are a common treatment modality for peripheral vascular disease. A relatively common complication is graft infection, occurring at a rate of 0.5-5%. When they occur, graft infections are associated with significant morbidity and mortality. Vascular graft infections also represent a diagnostic and therapeutic challenge for the physician METHODS: Here, we report a case where the rare finding of secondary hypertrophic osteoarthropathy was an important indication of underlying aortic graft infection that was initially misdiagnosed. A review of the literature revealed 34 cases of vascular graft infection associated with hypertrophic osteoarthropathy.
  
  
  RESULTS
  The mean interval from surgery to time of infection was approximately 5 years. Mortality was 35%. When combined with hypertrophic osteoarthropathy, vascular graft infection was complicated by an aortoenteric fistula in 53% of the cases.
  
  
  CONCLUSIONS
  The complexity of this case highlights the challenges physicians face in order to diagnose and treat this condition.
authors.affiliation: Department of Internal Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI.
authors.forename: Stephanie A
authors.initials: SA
authors.lastname: Chapman
authors.affiliation: Department of Internal Medicine, Michigan State University College of Human Medicine, Grand Rapids, MI.
authors.forename: Daniel
authors.initials: D
authors.lastname: Delgadillo
authors.affiliation: Department of Internal Medicine, Grand Rapids Medical Education Partners, Grand Rapids, MI.
authors.forename: Elizabeth
authors.initials: E
authors.lastname: MacGuidwin
authors.affiliation: Division of Infectious Disease, Departments of Vascular Surgery and Internal Medicine, Mercy Health Saint Mary's Hospital, Grand Rapids, MI.
authors.forename: Joshua I
authors.initials: JI
authors.lastname: Greenberg
authors.affiliation: Division of Infectious Disease, Departments of Vascular Surgery and Internal Medicine, Mercy Health Saint Mary's Hospital, Grand Rapids, MI. Electronic address: Andrew.Jameson@mercyhealth.com.
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Jameson
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D001011:Aorta / Q000601:surgery*; D001807:Blood Vessel Prosthesis / Q000009:adverse effects*; D019917:Blood Vessel Prosthesis Implantation / Q000009:adverse effects* / Q000295:instrumentation*; D020878:Device Removal; D003951:Diagnostic Errors; D017809:Fatal Outcome; D005260:Female; D005263:Femoral Artery / Q000601:surgery*; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D010005:Osteoarthropathy, Secondary Hypertrophic / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D058729:Peripheral Arterial Disease / Q000601:surgery*; D011237:Predictive Value of Tests; D016459:Prosthesis-Related Infections / Q000175:diagnosis* / Q000000981:diagnostic imaging / Q000382:microbiology / Q000601:surgery; D016896:Treatment Outcome