Infect Chemother.  2008 Jun;40(3):184-190. 10.3947/ic.2008.40.3.184.

A Case of 'True' Fungus-Infected Aneurysm of Abdominal Aorta in an Immunocompetent Patient

• Lee HY
• Kim TH
• Choo EJ
• Jeon MH
• Lee EJ
• Jung EJ
• Jeon SR
• Park EJ
• Youm W
• Jang WH
• Hwang JH
• Kim DH
• Kim DW

• KMID: 1782294
• DOI: http://doi.org/10.3947/ic.2008.40.3.184

Abstract

Infected aneurysms are uncommon, frequently fatal lesions. "True" fungus-infected aneurysms are even rarer. Fungal infections have high morbidity and mortality. However, diagnosis is frequently difficult, since the symptoms are non-specific and standard diagnostic procedures are often insensitive. We experienced a patient with persistent fever and negative blood cultures. The patient was immunocompetent and had no risk factors, and was diagnosed with a fungus-infected aneurysm based on computed tomography and vascular surgery. The vascular tissue revealed some narrow-based budding yeast within the thrombus, suggesting Candida infection. Seventeen cases of infected aneurysm of the abdomen were reported in Korea from 1988 to 2007, although none were "true" fungus-infected aneurysms, making this the first fungus-infected aneurysm of the abdomen in Korea. Prompt diagnostic procedures and aggressive treatment modalities are necessary for patients with occult infection and negative blood cultures, regardless of their immunocompetence, because of the high morbidity and mortality of this condition.

Keyword

Infected aneurysm; Fungus; Immunocompetent

MeSH Terms

Abdomen
Aneurysm
Aneurysm, Infected
Aorta, Abdominal
Candida
Fever
Fungi
Humans
Immunocompetence
Korea
Risk Factors
Saccharomycetales
Thrombosis

Figure

• 

  Fig. 1 Microscopic findings of the aneurysm with a thrombus (arrow). (A) (H & E, ×12.5) and marked infiltration of lymphocytes, plasma cells, and histiocytes in the wall (B) (H & E, ×400). Microscopic findings of the thrombi, showing irregular and ill-defined laminations (C) (H & E, ×12.5) and partly necrotic tissue with acute and chronic inflammatory cells (D) (H & E, ×100). A few yeast are present within the thrombi (E) (GMS, ×100) and a narrow-based budding yeast (arrow) (F) (GMS, ×400).

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  Fig. 2 Multidetector CT (MDCT) demonstration of thrombosed abdominal aortic aneurysms in a patient with infectious aortitis. A, B : Coronal MDCT images demonstrate aneurysmal dilatation of proximal abdominal aorta (arrows in A) and also involvement of distal abdominal aorta extending to aortic bifurcation and proximal both common iliac arteries (arrows in B).

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  Fig. 3 Axial MDCT images demonstrate aneurysmal dilatation of proximal abdominal aorta associated with irregular circumferential thrombus and periaortic enhancement consistent with active mural disease (arrows in A). Extension of inflammation into aortic branch vessels is well shown surrounding origin of the celiac artery (arrows in B) and superior mesenteric artery (arrows in C).

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  Fig. 4 Axial MDCT images demonstrate separate involvement in distal abdominal aorta (A). MDCT images shows propagation of aortitis with thrombus into aortic bifurcation (arrows in B) and proximal both common iliac arteries (arrows in C).

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  Fig. 5 MDCT with volume rendering (VR) reformation images nicely demonstrate proximal abdominal aortic aneurysm (blue arrow in A) and irregular luminal narrowing in distal abdominal aorta and proximal both common iliac arteries (red arrows in A). Origination of the celiac artery (blue arrow in B) and superior mesenteric artery (red arrow in B) from the dilated proximal abdominal aorta is well shown on right oblique sagittal VR image.

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