A Rare Case of Listeria Monocytogenes Causing Mycotic Aneurysm of the Common Femoral Artery: A Case Report

Overview

Journal Int J Surg Case Rep

Specialty General Surgery

Date 2019 Aug 6

PMID 31382235

Citations 1

Authors

T Pathmarajah

S Chu

K Sieunarine

Affiliations

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Abstract

Introduction: Mycotic aneurysms are an uncommon occurrence, withStaphylococcus and Salmonella species found to be the causative pathogen in up to 95% of cases. We believe this is the first described case of a common femoral artery mycotic aneurysm due to Listeria monocytogenes.

Presentation Of Case: A 66-year-old male presented with a two-month history of an increasing painful mass in his left groin, on the background of immunosuppression treatment for ankylosing spondylitis. He was afebrile on assessment, with a normal white cell count. Contrast enhanced CT scan showed a common femoral artery aneurysm, with no infective features. His aneurysm was excised and repaired with a Dacron tube graft. L. monocytogenes was cultured from the aneurysm tissue, and he was commenced on appropriate antibiotic treatment. The prosthetic graft was also replaced with a venous bypass of the aneurysm.

Discussion: L. monocytogenes is a rare cause of mycotic aneurysm with less than 40 cases reported in the literature. Immunosuppression is a recognised risk factor for Listerial infections. Immunocompromised patients may not display typical clinical or biochemical features associated with a mycotic aneurysm. Prosthetic graft infections are associated with significant mortality, with excision of the prosthetic material and venous reconstruction associated with good outcomes for eradicating infection.

Conclusion: This report highlights the importance of obtaining intraoperative tissue samples for microbiological and histopathological assessment in immunocompromised patients. This is important for the detection of rare organisms such as L.monocytogenes, requiring targeted antibiotic therapy. Inappropriate treatment of Listerial infections can result in serious invasive illness.

Citing Articles

Multiple liver abscesses secondary to complicated by hepatic artery mycotic aneurysm.

Qi X, Tamizuddin S, Gisi B, Lee P BMJ Case Rep. 2023; 16(8).

PMID: 37640412 PMC: 10462936. DOI: 10.1136/bcr-2023-256328.

References

Patra P, Ricco J, Costargent A, Goueffic Y, Pillet J, Chaillou P . Infected aneurysms of neck and limb arteries: a retrospective multicenter study. Ann Vasc Surg. 2001; 15(2):197-205. DOI: 10.1007/s100160010047. View

Oderich G, Panneton J, Bower T, Cherry Jr K, Rowland C, Noel A . Infected aortic aneurysms: aggressive presentation, complicated early outcome, but durable results. J Vasc Surg. 2001; 34(5):900-8. DOI: 10.1067/mva.2001.118084. View

Wing E, Gregory S . Listeria monocytogenes: clinical and experimental update. J Infect Dis. 2002; 185 Suppl 1:S18-24. DOI: 10.1086/338465. View

Daenens K, Fourneau I, Nevelsteen A . Ten-year experience in autogenous reconstruction with the femoral vein in the treatment of aortofemoral prosthetic infection. Eur J Vasc Endovasc Surg. 2003; 25(3):240-5. DOI: 10.1053/ejvs.2002.1835. View

Clouse W, DeWitt C, Hagino R, DeCaprio J, Kashyap V . Rapidly enlarging iliac aneurysm secondary to listeria monocytogenes infection: a case report. Vasc Endovascular Surg. 2003; 37(2):145-9. DOI: 10.1177/153857440303700211. View

Rohde H, Horstkotte M, Loeper S, Aberle J, Jenicke L, Lampidis R . Recurrent Listeria monocytogenes aortic graft infection: confirmation of relapse by molecular subtyping. Diagn Microbiol Infect Dis. 2004; 48(1):63-7. DOI: 10.1016/j.diagmicrobio.2003.08.003. View

Hsu R, Chen R, Wang S, Chu S . Infected aortic aneurysms: clinical outcome and risk factor analysis. J Vasc Surg. 2004; 40(1):30-5. DOI: 10.1016/j.jvs.2004.03.020. View

Yokoyama E, Tsuruoka S, Saitou Y, Ichinohe S . [Isolation of Listeria monocytogenes from a patient with sealed ruptured thoracoabdominal aortic aneurysm]. Kansenshogaku Zasshi. 2005; 78(12):1016-9. DOI: 10.11150/kansenshogakuzasshi1970.78.1016. View

Hsu R, Lin F . Surgical pathology of infected aortic aneurysm and its clinical correlation. Ann Vasc Surg. 2007; 21(6):742-8. DOI: 10.1016/j.avsg.2007.01.015. View

10.

Ehsan O, Gibbons C . A 10-year experience of using femoro-popliteal vein for re-vascularisation in graft and arterial infections. Eur J Vasc Endovasc Surg. 2009; 38(2):172-9. DOI: 10.1016/j.ejvs.2009.03.009. View

11.

Kim Y . Infected aneurysm: current management. Ann Vasc Dis. 2013; 3(1):7-15. PMC: 3595820. DOI: 10.3400/avd.AVDctiia09003. View

12.

Blair R, Resnik M, Polga J . CT appearance of mycotic abdominal aortic aneurysms. J Comput Assist Tomogr. 1989; 13(1):101-4. DOI: 10.1097/00004728-198901000-00021. View

13.

Elens M, Dusoruth M, Astarci P, Mastrobuoni S, Bosiers M, Nardella J . Management and Outcome of Prosthetic Vascular Graft Infections: A Single Center Experience. Vasc Endovascular Surg. 2018; 52(3):181-187. DOI: 10.1177/1538574418754453. View

14.

Agha R, Borrelli M, Farwana R, Koshy K, Fowler A, Orgill D . The SCARE 2018 statement: Updating consensus Surgical CAse REport (SCARE) guidelines. Int J Surg. 2018; 60:132-136. DOI: 10.1016/j.ijsu.2018.10.028. View

15.

Lorber B . Listeriosis. Clin Infect Dis. 1997; 24(1):1-9; quiz 10-1. DOI: 10.1093/clinids/24.1.1. View