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Streptococcus pneumoniae mycotic aortic aneurysm after allogeneic bone marrow transplantation
W Rabitsch1, S A Brugger, W Trubel
1Department of Medicine I, Bone Marrow Transplantation Unit, University of Vienna, Austria. Werner.Rabitsch@akh-wien.ac.at
Background:
Streptococcus pneumoniae (SP) is a common cause of community-acquired pneumonia and accounts for up to 30% of all cases of pneumonia. Patients with chronic graft-versus-host-disease (GvHD) after allogeneic bone marrow transplantation (BMT) have a high susceptibility to SP infections. So far, mycotic aneurysm resulting from SP has not been reported after BMT.
Methods:
We report on a patient with extensive, chronic GvHD who developed low back pain 22 months after allogeneic BMT.
Results:
Computed tomography of the abdomen displayed mycotic, saccular aneurysmatic enlargement of the infrarenal aorta, with leakage of contrast medium into the aneurysm. The aneurysm was resected, and the defect was closed with an autologous patch from the internal iliac artery. Bacteriologic samples from the abscess grew SP. The patient recovered uneventfully.
Conclusions:
This observation confirms the importance of pneumococcal prophylaxis after BMT and suggests that an aggressive diagnostic approach should always be considered in patients with chronic GvHD, even if they present with nonspecific symptoms.
Insights
This case report details a rare mycotic aneurysm caused by Streptococcus pneumoniae (SP) in a patient with chronic graft-versus-host-disease (GvHD) post-bone marrow transplant (BMT). Early diagnosis and treatment are crucial for managing such severe infections in immunocompromised patients.
Area of Science:
- Hematology
- Infectious Diseases
- Cardiovascular Surgery
Background:
- Streptococcus pneumoniae (SP) is a leading cause of community-acquired pneumonia.
- Patients with chronic graft-versus-host-disease (GvHD) post-allogeneic bone marrow transplantation (BMT) exhibit increased susceptibility to SP infections.
- Mycotic aneurysms due to SP have not been previously documented following BMT.
Observation:
- A patient with extensive chronic GvHD presented with low back pain 22 months after allogeneic BMT.
- Abdominal CT revealed a mycotic, saccular infrarenal aortic aneurysm with contrast leakage.
- Surgical resection and autologous arterial patching were performed.
Findings:
- Bacteriologic analysis of the abscess confirmed Streptococcus pneumoniae (SP) as the causative agent.
- The patient experienced an uneventful recovery after surgical intervention and treatment.
- This case highlights a rare complication of SP infection in an immunocompromised host.
Implications:
- Reinforces the critical need for pneumococcal prophylaxis in patients post-BMT.
- Suggests that a high index of suspicion and aggressive diagnostic workup are essential for patients with chronic GvHD presenting with nonspecific symptoms.
- Underscores the potential for serious, atypical infections in the immunocompromised population.