Mycotic aneurysm with recurrent sepsis complicating post-transplant nephrectomy

Abstract

A hypertensive 37-year-old man underwent renal transplantation. The transplanted kidney was removed 5 days later, 21 months before his death. He was maintained after transplantation by hemodialysis. His postoperative course was complicated by recurrent pseudomonal infection with bacteremia. He presented with symptoms of acute peritoneal irritation and hypovolemia followed by sudden death. Postmortem examination revealed that a saccular mycotic aneurysm of the left common iliac artery, which was the site of post-transplant nephrectomy, had ruptured into the peritoneal cavity. The case exemplifies postoperative mycotic aneurysm, the frequently obscure clinical findings of iliac artery aneurysms, and the need for a high index of suspicion of mycotic aneurysm in patients undergoing renal transplantation.