![]() She did not have any peripheral stigmata of infective endocarditis. On examination, her temperature was 39.5☌. Her other significant medical history included coronary artery bypass graft, congestive cardiac failure, infrarenal fusiform abdominal aneurysm (3 cm), hypertension with stage 3 chronic kidney disease and a 40 pack/year history of smoking. She represented after 1 week with a 2-day history of fever with chills and rigours. The admission was complicated with new-onset atrial fibrillation, which necessitated the initiation of anticoagulation therapy, following which she was discharged. 11 Our patient was treated with intravenous antibiotics together with thoracic endovascular aortic repair (TEVAR) with stenting, due to her age and other comorbidities.Īn 81-year-old woman was initially admitted to cardiology unit for treatment of angina that was secondary to anaemia requiring blood transfusion. 9 10 A disadvantage of EVAR is that the infected aneurysm is left behind which could lead to recurrent infections warranting lifelong antibiotics and follow-up, and therefore this is considered a palliative approach. 1 Endovascular aneurysm repair (EVAR) is becoming popular, particularly in patients who have a high surgical risk with a reported 2-year survival rate of over 70% reported with this procedure. Surgical treatment with extensive local debridement and re-vascularisation is considered to be the preferred option however, this is associated with high morbidity and mortality. There are no standardised guidelines to treat infected aneurysms. 5–7 There was only one other case of thoracic-infected aneurysm due to Proteus bacteraemia reported in the literature. ![]() ![]() ![]() 3 4 Infected aneurysm involving the thoracic aorta is much less common and most published cases were due to non-typhoidal Salmonella species and Staphylococcus aureus. These infected aneurysms are more frequently seen in the femoral arteries and are commonly due to invasive procedures followed by mycotic aneurysms in the intra-abdominal region. 1 2 We present a very rare case of Proteus mirabilis bacteraemia thought to have originated from an intrathoracic mycotic aneurysm. Although only 1%–4% of all the arterial aneurysms are mycotic, they cause significant morbidity and mortality. ![]()
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