Japan Medical Association Center for Clinical Trials, JMA-IIA00054.

HighlightsCase of infective endocarditis caused by a rare pathogen, Aggregatibacter aphrophilus is presented.Aggregatibacter aphrophilus can’t be detected by common culture methods.Br-PCR testing is a useful tool to identify pathogens of culture negative endocarditis.Serum PR3-ANCA can be positive in Aggregatibacter aphrophilus endocarditis.

Treating mycotic aortic aneurysm with thoracic endovascular aortic repair (TEVAR) remains controversial because of sustained infection post-treatment. In this study, an 83-year-old man, who had a ruptured mycotic thoracic aortic aneurysm, underwent salvage TEVAR. However, because an abscess appeared in the aneurysm on follow-up computed tomography, video-assisted thoracoscopic debridement (VATD) followed by continuous drainage was performed next and was successful in eliminating the infection from the abscess. Although frozen elephant trunk and proximal aortic arch repair were further required owing to another pseudoaneurysm, there was no sign of recurrent infection thereafter. The combination of TEVAR and VATD can be effective in treatment of mycotic aortic diseases in selected patients.

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