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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.