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Case Reports
. 2021 Mar 17;21(1):138.
doi: 10.1186/s12893-021-01142-1.

Aortic aneurysm and aortic graft infection related to Mycobacterium bovis after intravesical Bacille Calmette-Guérin therapy-a case series

M Buerger  1 , S Kapahnke  2 , S Omran  2 , M Schomaker  2 , M Rief  3 , A Greiner  2 , J P Frese  2
Affiliations
Case Reports

Aortic aneurysm and aortic graft infection related to Mycobacterium bovis after intravesical Bacille Calmette-Guérin therapy-a case series

M Buerger et al. BMC Surg. .

Abstract

Background: So called "mycotic" aortic aneurysms account for only 0.7 to 1.3% of all aortic aneurysms and are commonly caused by Staphylococcus aureus and Salmonella species. Bacillus Calmette-Guérin (BCG), a live attenuated strain of Mycobacterium bovis, is part of the therapy of non-muscle-invasive bladder cancer (NMIBC).

Case presentation: We report a case series of three patients with a mycobacterial graft infection related to BCG after surgical treatment of a presumed mycotic aortic aneurysm as an extremely rare complication after NMIBC treatment. All three patients developed aortic aneurysm after BCG instillation and subsequent mycobacterial graft infection.

Conclusion: Diagnosis requires a high degree of suspicion because of its nonspecific symptoms and imaging. The pathogen is not detected by standard microbiological testing. Treatment includes triple antimycobacterial therapy and radical surgical interventions. Graft preservation may be considered if no anastomosis is involved.

Keywords: Aortic surgery; Bladder cancer; Case report; Graft infection; Mycobacterium bovis; Mycotic aortic aneurysm.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
CT- reconstruction showing massive retroperitoneal fluid mass affecting left branch of aortobiiliac graft
Fig. 2
Fig. 2
Progress of periprosthetic fluid mass highly suspicious for mycobacterial graft infection and anastomotic pseudoaneurysm of the former implanted Dacron tube graft
Fig. 3
Fig. 3
Anastomotic pseudoaneurysm and progression of both periprosthetic fluid mass and fluid collection in left psoas muscle
See this image and copyright information in PMC

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