Mycotic pseudoaneurysm by vancomycin-intermediateStaphylococcus aureus: a rare cause of persistent bacteraemia

Abstract

SUMMARYPseudoaneurysms are vessel wall ruptures, that are often mistaken for deep vein thrombosis (DVT). A middle-aged man presented with right leg pain, swelling and erythema. His history was significant for persistent Staphylococcus aureus bacteraemia. Ultrasound revealed subacute DVT and laboratory parameters were suggestive of sepsis. He was started on intravenous heparin and antimicrobials. Owing to persistent anaemia despite blood transfusion, MRI of the right thigh was obtained. It revealed a 13×17 cm superficial femoral artery infected mycotic pseudoaneurysm (MPA) with a fresh haematoma. The patient underwent arterial ligation and extensive debridement. Intraoperative cultures revealed daptomycin-resistant vancomycin-intermediate S. aureus (VISA) and he was managed with 6 weeks of intravenous ceftaroline. MPAs are most common in the femoral artery and form <1% of aneurysms. Therapy involves surgical debridement and prolonged antimicrobials. VISA causing MPA is associated with worse outcomes. We report the first time use of ceftaroline in the management of a VISA MPA. BACKGROUND

Septic vasculitis secondary to mycotic pseudoaneurysm of the abdominal aorta by methicillin-resistent Staphylococcus aureus

“…Other causes are direct trauma to the vessel, such as vascular catheterization for any intervention or vascular surgery, and persistent bacteraemia due to intravenous drug abuse. The common complications of mycotic PA are life-threatening sepsis, rupture and fatal haemorrhage and systemic embolization [4]. The aetiology for mycotic PA in our patient was unclear.…”

“…The aetiologies of PA are iatrogenic, traumatic, anastomotic or infective [4]. The common presentation of infected aortic PA is a febrile illness with abdominal pain and a pulsatile lump.…”