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A complicated case of vascular Pythium insidiosum infection treated with limb-sparing surgery
Jenny H Pan1, Sid P Kerkar2, Michael P Siegenthaler3
1Surgery Branch, National Cancer Institute, National Institutes of Health (NIH), Bethesda, MD 20892, USA.
Introduction:
Pythiosis is a serious life- and limb-threatening infection endemic to Thailand, but rarely seen in the Western hemisphere. Here, we present a unique case of vascular pythiosis initially managed with limb-sparing vascular bypass grafts complicated by a pseudoaneurysm in our repair.
Presentation Of Case:
The patient is a 17 year-old Jamaican male with severe aplastic anemia. He sustained a minor injury to his left leg while fishing in Jamaica, which evolved to become an exquisitely tender inguinal swelling. His physical exam and imaging were significant for arteriovenous fistula with limb ischemia. Pathology obtained during surgery for an extra-anatomic vascular bypass showed extensive invasion by Pythium insidiosum. He later developed a pseudoaneurysm at the site of proximal anastomosis and required urgent intervention.
Discussion:
This patient presented with a rare, but classic case of vascular pythiosis, which was unrecognized at the time of presentation. A variety of therapeutic modalities have been used to treat this disease, including antibiotics, antifungals, and immunotherapy, but the ultimate management of vascular pythiosis is surgical source control.
Conclusion:
A high index of suspicion in susceptible patients is needed for timely diagnosis of vascular pythiosis to achieve optimal source control.
Insights
A rare vascular pythiosis infection in a Jamaican teen initially presented as an arteriovenous fistula. Surgical intervention was complicated by a pseudoaneurysm, highlighting the need for high suspicion and source control.
Area of Science:
- Infectious Diseases
- Vascular Surgery
- Mycology
Background:
- Pythiosis is a severe, limb-threatening infection endemic to Thailand, rarely seen in Western regions.
- Vascular pythiosis, caused by Pythium insidiosum, presents a diagnostic and therapeutic challenge.
- This case highlights a rare presentation in a young patient with underlying severe aplastic anemia.
Purpose of the Study:
- To report a unique case of vascular pythiosis in a 17-year-old Jamaican male.
- To describe the initial management with vascular bypass grafts and subsequent complications.
- To emphasize the importance of timely diagnosis and surgical source control for vascular pythiosis.
Main Methods:
- Case report of a 17-year-old male with a history of aplastic anemia.
- Initial presentation involved an inguinal swelling after a leg injury, diagnosed as arteriovenous fistula with limb ischemia.
- Surgical intervention included an extra-anatomic vascular bypass, with pathology revealing Pythium insidiosum invasion.
Main Results:
- The patient developed a pseudoaneurysm at the proximal anastomosis site of the vascular bypass graft.
- Pathology confirmed extensive invasion by Pythium insidiosum, indicating vascular pythiosis.
- The case illustrates the complexity of managing this rare infection, even after initial surgical repair.
Conclusions:
- Vascular pythiosis requires a high index of suspicion for early diagnosis, especially in endemic or potentially exposed areas.
- While various treatments exist, surgical source control remains the cornerstone of managing vascular pythiosis.
- Prompt diagnosis and intervention are crucial for limb and life salvage in cases of vascular pythiosis.
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