Candida infection associated with a solitary mycotic common iliac artery aneurysm

We report on a case of an isolated common iliac artery aneurysm infected by Candida albicans. To our knowledge, only one other case of this condition has been reported. The patient, a 49-year-old man with diabetes mellitus and a history of fungal urinary tract infections, had recurrent right knee pain and swelling. The knee effusion grew C albicans. Mild right hydronephrosis and a 4.6-cm aneurysm of the right common iliac artery without involvement of the aorta or iliac bifurcation was revealed by means of a computed tomography scan. The aneurysm wall was inflammatory, and there was associated purulence at the time of operation. The right ureter was densely adherent to the anterior aspect of the aneurysm, but could be palpated and dissected free because of a ureteral stent that was placed before the surgical incision. The aneurysm was resected, and the proximal and distal margins were oversewn without graft placement. C albicans was found in the resected aneurysm. The patient recovered without limb-threatening ischemia or claudication, but the distance he could walk remained limited because of right knee symptoms. The aneurysm may have formed by direct extension of infection from the right ureter or by hematogenous or lymphatic spread. This case raises interesting issues about operative strategies and etiology.