Anaemia secondary to Escherichia coli mycotic aneurysm

Abstract

Mycotic aneurysms can pose a diagnostic dilemma due to their variable presentations. We present a case of a 93-year-old man initially presenting with fevers, intermittent chest pain and normocytic anaemia refractory to repeated blood transfusions. He received intravenous ceftriaxone as Escherichia coli grew in his blood cultures. His chest X-ray showed a widened mediastinum. A subsequent CT of the chest discovered a mycotic aneurysm at the descending thoracic aorta. He had a good outcome and was thriving after 1 year post endovascular repair.

Keywords: infectious diseases; urinary tract infections; vascular surgery.

Figure 1

Chest X-ray (CXR) done 6 months prior to admission (left). Patient presented with non-productive cough at the time. Early consolidation in the right middle lobe was seen. CXR done on admission (middle). There was prominence of the aortic arch, coarsening of the bronchopulmonary markings bilaterally consistent with bronchiectasis and a small right pleural effusion. Follow-up CXR done on the third day of admission was not convincing of a new consolidation, but there was subtle expansion in the aortic arch (right).

Figure 2

CT of the chest done on day 4 of admission showed a large outpouching seen arising from the posterior aspect of the descending aorta measuring 36×22 mm with intramural haematoma (top left). CT angiogram of the thoracic aorta showing satisfactory appearance after thoracic endovascular aneurysm repair (TEVAR) with resolution of the aortic aneurysm (top right). Direct intensification image before TEVAR (bottom left) and immediately after TEVAR (bottom right).