Ruptured Thoracic Aortic Aneurysm Infected with Listeria Monocytogenes: A Case Report and a Review of Literature

Abstract

A 75-year-old male with a history of alcoholic liver cirrhosis, sigmoid colon cancer, and metastatic liver cancer was admitted to our institution with a complaint of a prickly feeling in his chest. On admission, a chest radiograph revealed a normal cardio-thoracic ratio of 47%. Echocardiography revealed pericardial effusion and blood chemical analyses revealed elevated C-reactive protein levels (14.7 mg/dL). On day 3, chest radiography revealed cardiomegaly with a cardio-thoracic ratio of 58% and protrusion of the left first arch. Contrast-enhanced chest computed tomography revealed a saccular aneurysm in the aortic arch with surrounding hematoma; thus, a ruptured thoracic aortic aneurysm was suspected. Emergency surgery was performed, which revealed a ruptured aortic aneurysm with extensive local inflammation. The diagnosis of an infected aortic rupture was therefore confirmed. The aneurysm and abscess were resected, followed by prosthetic graft replacement and omental packing. Histopathology of the resected aneurysm revealed gram-positive bacilli; and Listeria monocytogenes was confirmed as the causative organism by culture. Postoperative course was uneventful; on postoperative day 60, the patient was ambulatory and was discharged. Here we report the case of a male with a ruptured thoracic aortic aneurysm infected with L. monocytogenes.

Mycotic Aortic Aneurysms

“…Contrary to what happens in the infrarenal abdominal aorta, extra-anatomic bypasses are very exceptionally used to repair primary MAAs of the thoracic and DOI: http://dx.doi.org /10.5772/intechopen.86328 thoracoabdominal aorta, or graft infections on those sites. Patients with mycotic aneurysms of the ascending aorta or arch may present with different signs and symptoms, including persistent fever, fatigue, chest or back pain, dyspnea, pleural effusion, and hypovolemic shock in cases of mycotic aortic rupture [57].…”

“…Bacterial, viral, fungal, and protozoal infections have been described after cardiac transplantation, understanding that these patients under immunosuppressive medication are at risk of mycotic aneurysm formation [58]. In cases of ascending, arch, or descending thoracic mycotic aneurysms associated with severe mediastinitis, surgical techniques for aortic repair include cryopreserved arterial homografts, repair with deep or superficial femoral veins, coverage with the use of the greater omentum, creation of pedicled muscular flaps for arterial coverage, tissue debridement, and sternal re-closure [45,57,58].…”

Aortobronchial fistula andListeriaendograft infection after repeated T/EVAR: a rare combination

“…Additionally, L. monocytogenes is rarely detected in blood cultures and requires selective media for growth from tissue cultures. This indicates that endograft infections with L. monocytogenes usually have non-specific symptoms, and therefore clinicians should be vigilant during examination of such patients 3 19 20. Intravenous penicillin or amoxicillin with or without the synergistic combination of gentamicin is the treatment of choice.…”

“…The bacterium crosses the intestinal barrier by endocytosis of endothelial cells, leading to bacteraemia and potential adhesion to the aortic wall or to stent grafts. L. monocytogenes is also associated with rare cases of mycotic aneurysm formation 1–3…”

Psoas abscess associated with aortic endograft infection caused by bacteremia of Listeria monocytogenes

“…L monocytogenes may migrate from human intestine into bloodstream and disseminate hematogenously to adhere to the aortic wall, then spread locally surrounding the per aortic tissues. [1,5] The first choice of antibiotics is broad-spectrum penicillins like ampicillin coupled with synergistic aminoglycosides or sulfonamides. [5]…”