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Infectious Aneurysm Caused by Citrobacter koseri in an Immunocompetent Patient

Takahiro Ando1, Satoshi Noguchi1, Takako Enokida1

  • 1Department of Respiratory Medicine, The University of Tokyo, Japan.

Internal Medicine (Tokyo, Japan)
|November 20, 2018
PubMed

Insights

This case study highlights a rare infectious brachiocephalic artery aneurysm caused by Citrobacter koseri in an immunocompetent patient, originating from a periodontal infection.

Area of Science:

  • Infectious Diseases
  • Cardiovascular Surgery
  • Microbiology

Background:

  • Citrobacter species are known pathogens capable of causing severe infections, even in immunocompetent individuals.
  • Bacterial arteritis, particularly mycotic aneurysms, represents a serious vascular complication requiring prompt diagnosis and treatment.

Observation:

  • A 78-year-old immunocompetent male presented with recurrent monthly fevers and elevated C-reactive protein, initially suspected as pneumonia.
  • Contrast-enhanced computed tomography identified a saccular brachiocephalic artery aneurysm.
  • Blood cultures yielded Citrobacter koseri, leading to a diagnosis of infectious brachiocephalic artery aneurysm.

Findings:

  • The infectious aneurysm was successfully treated with a combination of intravenous cefepime and metronidazole for one month.
  • Endovascular aneurysm repair was performed following the antibiotic course.
  • This case represents the first documented instance of an infectious aneurysm caused by Citrobacter koseri originating from a periodontal infection in an immunocompetent patient.

Implications:

  • This case underscores the importance of considering rare bacterial causes for arterial aneurysms, even in immunocompetent hosts.
  • Periodontal infections should be recognized as a potential source for systemic dissemination leading to severe vascular complications.
  • Effective antibiotic therapy combined with endovascular repair can be a successful treatment strategy for infectious aneurysms.
Keywords:
Citrobacter koseribloodstream infectionendovascular aneurysm repairinfectious aneurysmperiodontal disease

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