Mycotic (Infected) Aneurysm Caused by Streptococcus pneumoniae

Khosrow Afsari, MD, Touro University College of Osteopathic Medicine, Vallejo, Calif; Robert Stallone, MD, Doctor's Medical Center, San Pablo, Calif; Glenn D. Wong, Touro University College of Osteopathic Medicine, Vallejo, Calif.

Disclosures

Infect Med. 2001;18(6) 

In This Article

Abstract and Introduction

Signs and symptoms of mycotic aneurysms may often be misleading during the early stages, resulting in misdiagnosis and delay in treatment. Mortality is greater than 90% in untreated patients. We report an unusual case of mycotic aneurysms caused by Streptococcus pneumoniae with associated thoracic vertebral osteomyelitis and adjacent pneumonitis.

Osler first used the term "mycotic aneurysm" in 1885 to describe a mushroom-shaped aneurysm in a patient with subacute bacterial endocarditis. This may create considerable confusion, since "mycotic" is typically used to define fungal infections. However, mycotic aneurysm is still used for all extracardiac or intracardiac aneurysms caused by infections, except for syphilitic aortitis.[1] The term "infected aneurysm," proposed by Jarrett and associates,[2] is more appropriate, since few infections involve fungi.

Mycotic aneurysms account for 2.6% of aortic aneurysms.[1] For the clinician, early diagnosis is the cornerstone of effective treatment. Without medical or surgical management, catastrophic hemorrhage or uncontrolled sepsis may occur. However, symptomatology is frequently nonspecific during the early stages, so a high index of suspicion is required to make the diagnosis. This article describes an unusual case of mycotic aneurysms caused by Streptococcus pneumoniae without the normal triad of symptoms: fever, leukocytosis, and palpable mass.

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