Infected thoracic aortic graft in a woman with Darier disease: a case report

Abstract

Background: Patients with Darier disease often present with staphylococcal skin infections and are at risk for complications when they undergo cardiothoracic surgery, such as acute aortic dissection repair.

Case summary: A 39-year-old woman with hypertension and Darier disease suffered an acute type A aortic dissection, requiring emergency operation with a Dacron graft. Twenty-five days post-operatively, she developed pneumonia and staph hominis was isolated in blood cultures and Bronchoalveolar Lavage. Following completion of antibiotics, multiple relapses occurred during a 6-month period, each time treated with appropriate antibiotic therapy. An 18F-fluorodeoxyglucose positron emission tomography computerized tomography showed persistent graft uptake and re-operation was performed. At 22 months of follow-up, the patient remains asymptomatic and the 18F-FDG PET/CT shows significant reduction in FDG uptake.

Discussion: Graft infection is a rare but serious complication. Antibiotic therapy is often inadequate and re-operation is needed. As staphylococcal skin infections often occur in patients with Darier disease, adequate preprocedural skin preparation and sterilization are very important in these patients.

Keywords: 18F-FDG PET/CT; Case report; Darier disease; Graft infection; Staphylococcus hominis.

Figure 1

Full body 18F FDG PET/CT scan (left) and transverse section at the level of pulmonary artery bifurcation (right), after initial antibiotic therapy (A), after multiple courses of antibiotics (B), and at 22 months post aortic graft re-operation (C), showing persistent hypermetabolic activity in (A) and (B), which is largely improved at (C).