Mycotic aneurysm in a turtle hunter: brief review and a case report

Abstract

Salmonella-associated mycotic aneurysm is a rare, but dreaded, complication of salmonellosis. Immunocompromised and elderly populations are more susceptible to develop this extra-intestinal complication. Salmonella is spread via fecal–oral and vehicle-borne routes. Reptiles, especially small pet turtles, have been linked with an increased risk of Salmonella infection. Diagnosis of mycotic aneurysm is a challenge due to atypical presentations. Recently, widespread use of CT scan imaging to evaluate for unexplained abdominal pain and sepsis has led to early identification of mycotic aneurysms. Antibiotic therapy and surgical intervention are the cornerstones of management. Open surgery has been the gold standard of treatment but is associated with increased morbidity and mortality. A relatively new alternative to open surgery is endovascular aneurysm repair (EVAR). It is comparatively less invasive and is associated with reduced early morbidity and mortality in the setting of mycotic aneurysm. However, there is a risk of late infection. Here, we present a patient with Salmonella mycotic aneurysm initially treated conservatively with antibiotic therapy who later underwent successful interval EVAR with no complications to date. Also included is a brief review of Salmonella-associated mycotic aneurysms.

Editor's notes

“…Case reports include a renal infarct following treatment for migraine ( 6 ); a salmonella-associated mycotic aneurism ( 7 ); a case-based review of the literature of the Brugada syndrome ( 8 ); cardiac tamponade caused by a seroma, years after a thymectomy for myasthenia gravis ( 9 ); Moyamoya disease in a 19-year-old American ( 10 ); presyncope in a patient from Shanghai due to non-compaction cardiomyopathy ( 11 ); and dramatic ECG images in a case of extraordinary hyperkalemia ( 12 ). Two dramatic clinical images are reported: Sister Mary Joseph's nodule secondary to lung cancer abdominal metastases ( 13 ) and a case of nummular eczema ( 14 ) submitted from Katmandu, Nepal.…”