Mycotic abdominal aortic aneurysm complicated by infective spondylitis due to P seudomonas aeruginosa

Abstract

A 67-year-old man with diabetes and hypertension presented with complaints of abdominal pain and lower back ache for 7 months, with intermittent episodes of fever. On examination, there was an expansile mass in the upper abdomen with bruit on auscultation. He also had tenderness in the L1-L2 vertebral space with paraspinal fullness, causing painful restriction of lower limb motor functions but without affecting sensation. On evaluation, he was found to have an abdominal aortic aneurysm with infective lumbar spondylodiscitis. The aspirate from the paravertebral infected tissue and cultures from blood grew Pseudomonas aeruginosa, a rare causative agent of mycotic aortic aneurysm. Whether the infective spondylitis spread to the abdominal aorta causing the mycotic aneurysm or vice versa is a dilemma in such a case. However, the mainstay of treatment remains adequate source control and repair of the aneurysm with appropriate antibiotic therapy. Our patient received intravenous antibiotics for P . aeruginosa based on sensitivity, following which he underwent debridement of the infective spondylodiscitis with aneurysmorrhaphy. He had an uneventful recovery and was well at 3-month follow-up.

Keywords: bone and joint infections; infections; orthopaedics; vascular surgery.

Figure 1

Contrast-enhanced CT scan of the abdomen and pelvis, axial and coronal cuts, showing loss of the L1–L2 disc space with destruction of the adjacent endplates and with necrotic areas in the paravertebral region, suggestive of lumbar infective spondylodiscitis (green arrowheads). Infrarenal abdominal aortic aneurysm with peripheral thrombi (red arrowheads).

Figure 2

Three-dimensional reconstructed images of the abdomen and pelvis showing an infrarenal abdominal aortic aneurysm measuring 58×56 mm with minimal peripheral thrombi (blue arrowheads), with erosion of the adjacent spine (green arrowheads). No evidence of aneurysmal leak or dissection.

Figure 3

Three-dimensional reconstructed images of the abdomen and pelvis postoperatively showing graft in the infrarenal abdominal aorta up to the aortic bifurcation, with good opacification and no evidence of endoleak or haematoma.