Streptococcus agalactiae infective endocarditis complicated by multiple mycotic hepatic aneurysms and massive splenic infarction: a case report

BMC Gastroenterology

Case Report

Luca Fumagalli¹  Marco Chiarelli¹  Ugo Cioffi²  Matilde De Simone²  Francesco Gabrielli³  Sabina Terragni³  Angelo Guttadauro³  Paolo Bonfanti⁴  Pietro Achilli⁵ 

[1] Department of Surgery, Ospedale Alessandro Manzoni, Lecco, Via dell’Eremo 9/11, 23900, Lecco, Italy;Department of Surgery, University of Milan, Milan, Italy;Department of Surgery, University of Milan-Bicocca, Istituti Clinici Zucchi, Via Zucchi, 24, 20900, Monza, Italy;Infectious Diseases Unit - A. Manzoni Hospital, Via dell’Eremo 9/11, 23900, Lecco, Italy;University of Milan - Fondazione IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Via Sforza 35, 20122, Milan, Italy;

关键词: Hepatic artery aneurysm;    Splenic infarction;    Infective endocarditis;    Streptococcus agalactiae;   

DOI  :  10.1186/s12876-017-0728-0

 received in 2017-05-03, accepted in 2017-12-14,  发布年份 2017

来源: Springer

【 摘 要 】

BackgroundThe burden of disease caused by Streptococcus agalactiae has increased significantly among older adults in the last decades. Group B streptococcus infection can be associated with invasive disease and severe clinical syndromes, such as meningitis and endocarditis.Case presentationWe present the case of a 56-year-old man who developed multiple mycotic aneurysms of the right hepatic artery and massive splenic infarction as rare complications of Streptococcus agalactiae infective endocarditis. The patient underwent urgent right hepatic artery ligation and splenectomy. The postoperative course was complicated by an episode of hemobilia due to the rupture of a partially thrombosed mycotic aneurysm into the biliary tree. Thus, selective radiological embolization of the left hepatic artery branches was necessary.ConclusionTo our knowledge, this is the first case reported of infected aneurysms of visceral arteries caused by Group B streptococcus infection. Clinical and laboratory findings were non-specific, while imaging features with computed tomography scan and angiography were highly suggestive. In our case, early recognition, culture-specific intravenous antibiotics and urgent surgical treatment combined with interventional radiology played a decisive role in the final result.

【 授权许可】

CC BY   
© The Author(s). 2017