We report a case of mycotic aneurysms due to Staphylococcus aureus infection in the left anterior descending coronary artery in a 56-year-old male after implantation of a sirolimus-eluting stent. This is an unreported complication of a drug-eluting stent.

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A 62-year-old man with a history of hyperlipidemia and prolonged smoking presented for evaluation of impotence and recent exertional thigh and buttock claudication after starting an exercise regimen. His examination demonstrated nonpalpable right and weak left lower extremity pulses. Doppler ultrasonography (A) revealed low velocity flow and loss of normal triphasic waveforms in the femoral arterial vasculature bilaterally. Three-dimensional volume-rendered reconstructions (B) from computed tomography angiography showed abdominal aortic occlusion below the origin of renal arteries (white arrowhead) and collateral circulation from the lower intercostals to the common femoral arteries (CFAs). These collaterals bilaterally fill the deep iliac circumflex arteries (red arrows) and inferior epigastric arteries (blue arrows). The arc of Riolan (white arrows), a central collateral pathway between the superior mesenteric artery and inferior mesenteric artery vascular distributions, is clearly opacified. These findings are classical for Leriche syndrome. The patient refused aortobifemoral bypass grafting.

SummaryA 78-year-old, retired Caucasian male presented in emergency room with 3 days history of progressive watery diarrhoea. Two weeks earlier, he received intravenous levofl oxacin for community acquired pneumonia. The patient was diagnosed as severe Clostridium diffi cile infection based on clinical presentation, labs and imaging studies. The patient was initially treated with intravenous metronidazole and oral vancomycin. While awaiting subacute rehabilitation placement, the patient relapsed twice. After fi rst recurrence the patient was treated with 2 weeks of oral nitazoxanide. After second recurrence, the patient was treated 2 weeks of nitazoxanide followed by tapering dose of vancomycin. The patient was followed and no relapse was reported at 1 year follow-up visit.

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