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Case Reports
. 2013 Jun 24:2013:bcr2012008499.
doi: 10.1136/bcr-2012-008499.

Streptococcus pneumoniae mycotic aneurysm with contiguous vertebral discitis treated by endovascular aortic repair and antibiotics

Karen Watura  1 , Michael Katsimihas, Martin Williams
Affiliations
Case Reports

Streptococcus pneumoniae mycotic aneurysm with contiguous vertebral discitis treated by endovascular aortic repair and antibiotics

Karen Watura et al. BMJ Case Rep. .

Abstract

A 61-year-old man was admitted with a history of right upper quadrant and left iliac fossa pain and raised inflammatory markers. Initial investigations, including contrast-enhanced CT scan of the abdomen and pelvis, were reported as normal. Following readmission 2 months later with thoracolumbar back pain and recurrent fevers, an MRI showed T11/12 discitis and an adjacent mycotic aneurysm of the aorta. CT angiogram confirmed an 8 cm mycotic aneurysm. A second, more distal aneurysm was found located at the left common femoral artery. The aortic aneurysm was treated by antegrade stenting. The left common femoral artery aneurysm was excised. The patient was also treated with antibiotics. He made a good recovery and was well 8 months later apart from mild residual thoracolumbar spinal pain. To date, he has been followed up for 1 year and remains asymptomatic.

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Figures

Figure 1
Figure 1
Ultrasound scan of 6 March 2012 reported as normal, but in retrospect it shows a mycotic aneurysm (white arrow).
Figure 2
Figure 2
Sagittal T2-weighted MRI showing mycotic aneurysm abutting the T11 and T12 vertebral bodies. The scan also shows high signal in the disc space at T11/12 in keeping with discitis (white arrow).
Figure 3
Figure 3
CT scan showing contrast in the aorta (black arrow) and the aneurysm which is of lower density (white arrow). The aneurysm extends posteriorly behind the aorta and is eroding the adjacent vertebral bodies.
Figure 4
Figure 4
Sagittal CT scan showing mycotic aneurysm eroding T11 and 12 vertebral bodies.
Figure 5
Figure 5
Angiogram showing mycotic aneurysm (black arrow).
See this image and copyright information in PMC

References

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