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Publication Date
2025
Keywords
oregon, oaa 2025, oregon gme, ppmc
Disciplines
Medical Education | Oncology | Pulmonology
Abstract
Introduction: Mycotic Aneurysm: Dilation of an arterial wall due to infection • Majority are bacterial, Staphylococcus and Salmonella • Called mycotic because it resembled the appearance of fleshy fungus1 • Most commonly in femoral artery, aorta, and visceral Causes • Form from adjacent bacteria infections • Lung, esophagus, endocarditis • Direct invasion of vessel walls or atherosclerotic plaque in bacteremia General Presentation • Fever, back pain, immunocompromised, IV drug user • Positive blood cultures 50-85%2 • Elevated WBC, ESR, CRP • Lack of standard criteria for diagnosis and management Risk Factors • Tobacco • Atherosclerosis • Diabetes Mellitus Case Presentation: • A 74 year old male presents with worsening fevers and generalized body pains over the last three weeks. In addition he endorsed weight loss, chills, sweats, generalized body aches, and hoarseness of voice • Patient had a above knee amputation 5 weeks ago and he started to have fevers and was started on Augmentin. • Wound cultures at this time grew Staph aureus and enterococcus faecalis. • Started on ceftriaxone and vancomycin outpatient • Incidentally during history on admission patient mentions blood streaks in mucus when patient coughs for the last few days • Blood culture: Positive for methicillin sensitive staph aures Discussion: Would we approach a similar patient in the future differently? • The lack of clear diagnostic criteria other than imaging makes this difficult to diagnose. • Should the initial CT have been one with contrast? Inflammation around a vessel can look like a mass around a vessel. • You cannot diagnose patient with lung cancer until the results of pathology come back. • A primary lung nodule if found incidentally on CT many years ago likely did not become lung cancer This case shows a rare complication from an infection that requires complex and urgent medical management that can present in an incidental manner • Really difficult to predict manifestation of infection or sepsis around the body.
Area of Special Interest
Cancer
Specialty/Research Institute
Graduate Medical Education
Specialty/Research Institute
Oncology
Specialty/Research Institute
Pulmonary Medicine
