Abstract
Background
The role of endoscopic ultrasound (EUS) has expanded over the last decade. It is a well-established imaging modality in the diagnosis of gastrointestinal and pancreatic lesions as well as in mediastinal lesions. To date, EUS has not been reported in the literature for the diagnosis of mycotic aortic aneurysm after intravesical bacille Calmette-Guérin (BCG) therapy.
Aims
This case report describes the presentation and diagnosis of a mycotic aneurysm in the context of disseminated Mycobacterium bovis infection.
Methods
An 86-year-old man with previous intravesical BCG immunotherapy for the treatment of bladder carcinoma presented with weight loss and deconditioning at admission. Based on the patient’s past medical history and age, malignancy was suspected. An endoscopic ultrasound (EUS) revealed a mass at the lymph node station 9 masquerading as a lymphadenopathy. Multiple investigations were completed. Following the second EUS, the diagnosis of mycotic aneurysm was raised. The smear collected with EUS guided fine needle aspiration (FNA) was positive after Ziehl-Neelsen staining. The diagnosis of mycotic aneurysm to Mycobacterium bovis was confirmed.
Results
Treatment was initiated with rifampin, isoniazid and ethambutol. Despite optimal medical management, the patient presented with new onset fever, and a clinical deterioration with positive mycobacterial blood cultures. Within two months of admission, the treatment was discontinued and the patient died in palliative care.
Conclusions
Recognition of mycotic aneurysms is critical for institution of appropriate therapy and averting more severe complications, as they are associated with significant morbidity. This case aims to raise awareness to this rare disease after BCG treatment. It also highlights the novel role of EUSin the challenging diagnosis of mycotic aneurysm.
Funding Agencies
None
A mycotic aortic aneurysm treated by thoracic endovascular aneurysm repair
