A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia
Background. An aortoenteric fistula (AEF) describes a communication of the aorta or aortic graft with an adjacent loop of the bowel. Aortic graft erosion is a rare complication of abdominal aortic aneurysm repair. We describe a case of a patient presenting with sepsis from Candida glabrata fungemia...
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| Format: | Article |
| Language: | English |
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Wiley
2021-01-01
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| Series: | Case Reports in Vascular Medicine |
| Online Access: | http://dx.doi.org/10.1155/2021/9002143 |
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| author | Muhammad Adeel Samad Dhaval Patel Martin Asplund Diane C. Shih-Della Penna Yaseen Tomhe |
| author_facet | Muhammad Adeel Samad Dhaval Patel Martin Asplund Diane C. Shih-Della Penna Yaseen Tomhe |
| author_sort | Muhammad Adeel Samad |
| collection | DOAJ |
| description | Background. An aortoenteric fistula (AEF) describes a communication of the aorta or aortic graft with an adjacent loop of the bowel. Aortic graft erosion is a rare complication of abdominal aortic aneurysm repair. We describe a case of a patient presenting with sepsis from Candida glabrata fungemia secondary to aortoenteric erosion without any symptoms or signs of gastrointestinal bleeding. This is a unique case of Candida glabrata fungemia from aortoenteric graft erosion. Case Summary. This patient is a 75-year-old male with a history of a prior aortobifemoral bypass graft in 2005. He presented with complaints of right paraspinal pain and chills. He had no symptoms of gastrointestinal bleeding or abdominal pain. His white blood cell count was 25,600/mcl (4,000–11,000/mcL) with left shift. The erythrocyte sedimentation rate was 11 mm/hr (0-38 mm/hr), and C-reactive protein was 95.5 mg/L (<=10.0 mg/L). Blood cultures were obtained and eventually grew Candida glabrata. A computed tomography angiogram (CTA) of abdomen and pelvis demonstrated inflammation surrounding the graft concerning for graft infection with additional inflammatory changes tracking down both femoral limbs. He underwent staged bilateral femoralaxillary bypass followed by the excision of aortobifemoral bypass. Conclusion. Patients with aortoenteric erosion can present with sepsis in absence of gastrointestinal bleeding. Emergent computed tomography angiogram (CTA) of abdomen and pelvis should be performed to assess for aortic graft erosion or fistula. Empiric treatment with antibiotics should include antifungal agent like micafungin until the final culture is reported. The definite management is an extra anatomic bypass, followed by graft excision. |
| format | Article |
| id | doaj-art-c7ccb79de0e04822a5cc5d60359d8e49 |
| institution | Kabale University |
| issn | 2090-6994 |
| language | English |
| publishDate | 2021-01-01 |
| publisher | Wiley |
| record_format | Article |
| series | Case Reports in Vascular Medicine |
| spelling | doaj-art-c7ccb79de0e04822a5cc5d60359d8e492025-08-20T03:24:10ZengWileyCase Reports in Vascular Medicine2090-69942021-01-01202110.1155/2021/9002143A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata FungemiaMuhammad Adeel Samad0Dhaval Patel1Martin Asplund2Diane C. Shih-Della Penna3Yaseen Tomhe4Wellspan York HospitalWellspan York HospitalWellspan York HospitalWellspan York HospitalWellspan York HospitalBackground. An aortoenteric fistula (AEF) describes a communication of the aorta or aortic graft with an adjacent loop of the bowel. Aortic graft erosion is a rare complication of abdominal aortic aneurysm repair. We describe a case of a patient presenting with sepsis from Candida glabrata fungemia secondary to aortoenteric erosion without any symptoms or signs of gastrointestinal bleeding. This is a unique case of Candida glabrata fungemia from aortoenteric graft erosion. Case Summary. This patient is a 75-year-old male with a history of a prior aortobifemoral bypass graft in 2005. He presented with complaints of right paraspinal pain and chills. He had no symptoms of gastrointestinal bleeding or abdominal pain. His white blood cell count was 25,600/mcl (4,000–11,000/mcL) with left shift. The erythrocyte sedimentation rate was 11 mm/hr (0-38 mm/hr), and C-reactive protein was 95.5 mg/L (<=10.0 mg/L). Blood cultures were obtained and eventually grew Candida glabrata. A computed tomography angiogram (CTA) of abdomen and pelvis demonstrated inflammation surrounding the graft concerning for graft infection with additional inflammatory changes tracking down both femoral limbs. He underwent staged bilateral femoralaxillary bypass followed by the excision of aortobifemoral bypass. Conclusion. Patients with aortoenteric erosion can present with sepsis in absence of gastrointestinal bleeding. Emergent computed tomography angiogram (CTA) of abdomen and pelvis should be performed to assess for aortic graft erosion or fistula. Empiric treatment with antibiotics should include antifungal agent like micafungin until the final culture is reported. The definite management is an extra anatomic bypass, followed by graft excision.http://dx.doi.org/10.1155/2021/9002143 |
| spellingShingle | Muhammad Adeel Samad Dhaval Patel Martin Asplund Diane C. Shih-Della Penna Yaseen Tomhe A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia Case Reports in Vascular Medicine |
| title | A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia |
| title_full | A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia |
| title_fullStr | A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia |
| title_full_unstemmed | A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia |
| title_short | A Rare Case of Aortoenteric Graft Erosion Presenting as Candida glabrata Fungemia |
| title_sort | rare case of aortoenteric graft erosion presenting as candida glabrata fungemia |
| url | http://dx.doi.org/10.1155/2021/9002143 |
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