Mycotic Aneurysm of the Abdominal Aorta into the Celiac Axis due to Methicillin-Sensitive Staphylococcus Aureus

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Background: A mycotic aneurysm (MA) is an abnormal focal arterial dilation resulting from a preexisting bacterial infection or septic embolization. It is estimated that more than one million people are living with an undiagnosed abdominal aortic aneurysm. MAs account for 2% of all aneurysms. Ruptured abdominal aneurysms are fatal for approximately 3 out of 4 patients, however, if detected prior to rupture at least 95% of these aneurysms can be treated. This case study documents the diagnosis of a MA in an 81-year-old male that presented to the ER and emphasizes the importance of persistence in diagnostic studies. Methods & Materials: The patient presented to the ER with a 104F fever and loose bowel movements during his fifth week of intravenous antibiotic for a MSSA infection that had been diagnosed 5 weeks prior. The patient underwent a CT scan and blood work. Results: The patient was diagnosed with sepsis and a MA measuring 16 mm × 15 mm located anterior to the abdominal aorta into the left of the celiac axis. The patient's ESR, CRP, and neutrophil count peaked on the day he presented to the ER. A CT scan 2 months post diagnosis showed that the MA had thrombosed. Conclusion: Due to their rarity, MAs may not be the first differential to be considered. However, given their high mortality rate they should be assessed for in patients that present symptoms especially high-risk patients such as patients over 60 years old and the immunocompromised. It is important to educate patients with infections due to Salmonella sp. and/or Staphylococcus aureus, the bacteria most often associated with MA, of their increased risk of developing a MA and the symptoms they should monitor. It is important to monitor patients with MAs regularly using imaging since inflammatory markers insufficient due to their lack of specificity.

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