A Rare Case of Serratia marcescens Causing Mycotic Aneurysm and Septic Emboli in Intravenous Drug User

Abstract

There are few literatures highlighting the presence of a mycotic aneurysm in the setting of bloodstream infection by Serratia. A 33-year-old male with a history of Marfan syndrome, mitral valve prolapse, and intravenous drug use (IVDU) presented to the ED with fever, nausea, and non-bloody emesis, and vague abdominal pain with concern for sepsis. With the strong association between IVDU and infective endocarditis, transthoracic and transesophageal echocardiograms were performed and were negative for vegetations. Abdominal CT and positron emission tomography (PET) scan were performed and revealed thrombosis at the first jejunal branch of the superior mesenteric artery (SMA), left renal pole infarct, and superior splenic pole infarct. Following CT angiography for potential thrombolysis, aneurysmal formation was discovered proximal to the filling defect within mid-SMA. Blood cultures drawn at presentation grew Serratia marcescens. The patient was treated with appropriate antibiotic, and recommended indefinite anticoagulation. The patient was then recommended to follow up with vascular surgery within two weeks for repeat abdominal CT angiogram.

А Rare Case of an Infected, Ruptured Popliteal Artery Aneurysm Occurring Following Surgical Treatment for Panaritium

“…The Serratia genus, overall, contributes to approximately 2% of nosocomial infections, spanning urinary tract infections, bloodstream infections, sepsis, pneumonia, meningoencephalitis, and other debilitating infections. However, it is rarely reported as a causative agent of mycotic aneurysms [ 11 ], primarily occurring in immunocompromised patients [ 12 ]. Additionally, a superinfection involving multidrug-resistant Klebsiella pneumoniae (likely nosocomial) was isolated from the popliteal wound a week after initiating appropriate antibiotic treatment for Serratia, which necessitates the introduction of a second antibiotic agent.…”

A mycotic aneurysm of a jejunal branch treated by aneurysmectomy without bowel resection

“…Also, embolization of the intrahepatic pseudoaneurysms at the IV-B segment was the chosen method because of the better accessibility via an endovascular approach compared with open surgery, although the etiology was not optimal for this type of procedure. 17 , 18 , 19 , 20 According to the Society for Vascular Surgery guidelines, strong evidence suggests that coil embolization of intrahepatic pseudoaneurysms is the treatment of choice. 21 …”

“… 11 Only six other mycotic jejunal pseudoaneurysm cases are documented, four involving aneurysmectomy alone, one involving ligation and excision with segmental bowel resection, and one treated conservatively without surgical intervention due to its distal location. 19 , 21 , 22 , 23 …”

Serratia marcescens Infection-Associated Loss of Vision: A Case Report in a Patient with a History of Intravenous Drug Use

“…In the few cases of septic emboli from S. marcescens endocarditis associated with IV drug use reported in the literature [ 6 – 8 ], the spleen, kidneys, and CNS were commonly involved. Vascular complications of superior mesenteric artery mycotic aneurysm also have been reported [ 6 ]. In our patient, the stomach, lung, and eye were involved.…”