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Multiple mesenteric aneurysms complicating subacute bacterial endocarditis.

M F Trevisani, M A Ricci, R M Michaels

    Archives of Surgery (Chicago, Ill. : 1960)
    |July 1, 1987
    PubMed
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    Multiple visceral aneurysms, typically linked to periarteritis nodosa, were observed in a patient with enterococcal endocarditis. This case suggests an immune-mediated vasculitis, not a direct infection, as the cause of these arterial abnormalities.

    Area of Science:

    • Vascular Medicine
    • Infectious Diseases
    • Rheumatology

    Background:

    • Multiple visceral aneurysms are characteristic, though not pathognomonic, on arteriography in periarteritis nodosa.
    • This arteriographic pattern has been previously associated with hairy-cell leukemia, collagen vascular disorders, and atrial myxoma.

    Observation:

    • A patient with enterococcal endocarditis experienced two separate intra-abdominal hemorrhages within 24 hours.
    • The hemorrhages originated from aneurysms in the middle colic and left colic arteries.
    • Diagnostic findings included sterile vessel cultures, inflammatory infiltrates, decreased complement levels, and positive rheumatoid factor.

    Findings:

    • The arteriographic evidence of multiple visceral aneurysms in this context, coupled with sterile cultures, suggests an immune-mediated vasculitis.

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  • The findings indicate that the vasculitis was not mycotic (caused by fungi or bacteria directly infecting the vessel wall).

    • Implications:

    • This case expands the known associations of multiple visceral aneurysms to include subacute bacterial endocarditis.
    • It highlights the potential for immune-mediated vasculitis secondary to endocarditis.
    • Effective management involved hemorrhage control followed by antibiotic therapy, resolving abdominal symptoms.