Mycotic Pseudoaneurysm of the Femoral Artery in a Patient with Psoriasis

Abstract

Mycotic aneurysms of the common femoral artery are rare and usually occur in intravenous drug abusers who use the femoral vessels for injection. We herein describe a case of mycotic aneurysm of the common femoral artery caused by methicillin-sensitive Staphylococcus aureus seeding of an atherosclerotic plaque in which the bacteria possibly originated from psoriatic skin lesions. A 67-year-old Caucasian man was admitted to the hospital after experiencing chest pain for two days. He was known to have psoriasis and coronary artery disease with a history of coronary artery bypass grafting surgery three years earlier. He was found to have methicillin-sensitive Staphylococcus aureus bacteremia and later developed a mycotic aneurysm of the femoral artery opposite to the site of catheterization access. Mycotic aneurysms are rare clinical conditions associated with significant morbidity and mortality. In patients with psoriasis, a high prevalence of Staphylococcus aureus colonization of the skin makes possible bacterial seeding of existing atherosclerotic plaques. Therefore, the risk of mycotic pseudoaneurysm formation in these patients should be considered.

Uterine artery pseudoaneurysm hidden behind septic abortion: Pseudoaneurysm without preceding procedure

“…We speculate that infection of the conceptus and surrounding tissues may have spread to some adjacent artery, the uterine artery or its branch, leading its wall injury, ending in UAP formation. In fact, infection caused pseudoaneurysm in the femoral artery without preceding traumatic procedures: in that case, bacteremia also coexisted, similar to the present patient. In the present patient, a small rupture and then its covering may have occurred repeatedly, which caused irregular bleeding.…”

Staphylococcus hominis carotid artery infection with septic embolization

“…Additional cases of more indolent Staphylococcus spp have also been reported 5 . Bacterial seeding of aortic and common femoral artery plaques has been reported,7, 8 but to our knowledge, there are no reports of carotid plaque infections without pseudoaneurysms. The scarcity of these cases makes it difficult to determine if more recently isolated pathogens, such as S hominis, are changing the clinical presentation of these infections.…”

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

“…Most cases of MPA are associated with a pulsatile swelling, and can be accompanied by signs of distal ischaemia 7. Delayed diagnosis is associated with higher mortality and morbidity with complications such as distal ischaemia, acute haemorrhage, nerve palsy and rarely super-infection 3 8. They present a significant diagnostic challenge, especially if present in a setting not associated with recent arterial manipulation.…”