Pseudoaneurysm of the ascending aorta: case report of a donor-derived Pseudomonas infection in a heart transplant recipient

BMC Infectious Diseases

Tamás Varga¹  Ákos Király²  Miklós Pólos²  Ákos Pataki²  Zoltán Szabolcs²  Zsófia Szakál-Tóth²  Gyula Prinz²  Nóra Parázs²  Balázs Sax²  Zoltán Tarjányi²  Szilvia Kugler²  Ádám Koppányi²  István Hartyánszky²  Tímea Teszák²  Béla Merkely² 

[1] Department of Anesthesiology and Intensive Therapy, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary;Heart and Vascular Center, Semmelweis University, 68 Városmajor Street, 1122, Budapest, Hungary;

关键词: Aortic pseudoaneurysm;    Pseudomonas aeruginosa;    Heart transplantation;    Donor-derived infection;    Case report;   

DOI  :  10.1186/s12879-021-06557-y

来源: Springer

【 摘 要 】

BackgroundMycotic aortic pseudoaneurysm is a rare complication after heart transplantation (HTX) with remarkable mortality. Intrathoracic infection is a well-documented predisposing factor for this disease. Staphylococcus aureus, Pseudomonas aeruginosa or Candida species are commonly isolated from resected specimens of the pseudoaneurysms. We demonstrate a unique case of mycotic pseudoaneurysm caused by presumably donor-derived Pseudomonas infection in a heart transplant recipient.Case presentationOur 67-year-old male patient treated with diabetes mellitus underwent HTX. The donor suffered from epiglottic abscess and pneumonia with known microorganisms including Pseudomonas, therefore both the donor and recipient received targeted antimicrobial therapy and prophylaxis. Five months after the uneventful HTX, lab test of the asymptomatic patient showed moderate, increasing C-reactive protein level without obviuos source of infection. Chest computed tomography showed a large (90 mm) saccular dilatation of the tubular portion of ascending aorta. Urgent surgical intervention identified a pseudoaneurysm, histological examinations and cultures of the resected aorta verified Pseudomonas aeruginosa aortitis, while all blood cultures remained negative. Retrospective interrogation of other transplanted organs of the donor supported donor-derived infection as the transport fluid of the right kidney grew Pseudomonas. The patient received 3 weeks of ceftazidime followed by 7 months of oral ciprofloxacin therapy. One year after the operation the patient was asymptomatic with normal inflammatory markers.ConclusionsDonor-derived infection is a rare but potential cause of aortitis. Early diagnosis, surgical intervention and adjuvant antibiotic therapy seem to be the keys to successful management of mycotic pseudoaneurysms after HTX.

【 授权许可】

CC BY