Femoral artery aneurysm with large hematoma from Pasteurella: case report and literature review

Abstract

Background: Pasteurella multocida is a well-known gram-negative facultative anaerobe well known for its ability to cause soft tissue infections following animal bite or scratch. Here we present a case with mycotic aneurysm of the superficial femoral artery due to P. multocida infection.

Case presentation: A 62 year old male patient presented with worsening right leg pain and swelling. On examination, he was found to have profound swelling and erythema of the right medial thigh and tenderness to palpation. Computerized tomography showed findings suggestive of right femoral pseudoaneurysm with a large right medial thigh hematoma. Blood cultures grew P. multocida. Patient underwent emergent open resection of the mycotic aneurysm and vascular bypass surgery. Intraoperatively, the site was noted to be grossly infected with multiple pockets of pus which were drained and pus cultures grew P. multocida. The diagnosis of P. multocida bacteremia with right femoral mycotic aneurysm and thigh abscess was made. Patient received 6 weeks of intravenous ceftriaxone and recovered.

Conclusion: Our case is the first report on infection of peripheral vessel with Pasteurella and highlights the importance of prompt surgical intervention and effective antibiotic treatment.

Keywords: Case report; Femoral artery; Mycotic aneurysm; Pasteurella.

Fig. 1

CT angiogram of right leg. CT angiogram with contrast of the right lower limb showing enhancement of the mycotic aneurysm (A) and hematoma formation (B)

Fig. 2

Histology of resected aneurysmal tissue. Hematoxylin and eosin stain of the excised aneurysmal tissue revealed bacterial colonies in the vascular wall tissue at (40× magnification) (A). The bacterial colonies are better seen at a higher power (400× magnification) (B). Gram stain of the tissue shows gram-negative bacteria (C)