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Updated: Jan 20, 2026
Porcine Model of Infrarenal Abdominal Aortic Aneurysm
Published on: November 21, 2019
An Unusual Case of Streptococcus pyogenes Causing Ruptured Aortic Mycotic Aneurysm
1Department of Medicine, McMaster University, 1280 Main St W, Hamilton, ON L8S 4L8, Canada.
Abstract:
A 70-year-old male with a complex past medical history presents with confusion and slurred speech for 24 hours. His exam was unremarkable, and his CT head was negative. Both his C-reactive protein and white blood cell count were elevated. As part of the delirium workup, blood cultures were done which grew Streptococcus pyogenes with no obvious source. He was treated with appropriate antibiotics. To determine the source, a white blood cell scan was done, which showed increased localization within a left-sided upper mediastinum mass. Subsequently, chest CT scan with contrast showed an acute type B aortic dissection with mycotic aneurysm. Consequently, he was taken urgently for surgical management. He completed 6 weeks of penicillin G and was discharged to a rehabilitation center. This case illustrates both a rare entity, mycotic aneurysm secondary to Streptococcus pyogenes, and the importance of getting an Infectious Diseases consult in the setting of an unknown source of bacteremia.
Insights
A rare case of Streptococcus pyogenes causing a mycotic aneurysm in a 70-year-old male was identified. Prompt Infectious Diseases consultation is crucial for diagnosing unknown bacteremia sources.
Area of Science:
- Infectious Diseases
- Cardiology
- Radiology
Background:
- A 70-year-old male presented with acute confusion and slurred speech.
- Initial workup revealed elevated inflammatory markers (C-reactive protein, white blood cell count) and negative CT head.
- Blood cultures identified Streptococcus pyogenes without an apparent source.
Observation:
- A white blood cell scan indicated increased uptake in a left upper mediastinal mass.
- A subsequent CT scan revealed an acute type B aortic dissection with a mycotic aneurysm.
Findings:
- The patient was diagnosed with a rare mycotic aneurysm secondary to Streptococcus pyogenes.
- Urgent surgical intervention was performed for the aortic dissection and mycotic aneurysm.
Implications:
- This case highlights the importance of considering rare infectious etiologies for aneurysms.
- Emphasizes the critical role of Infectious Diseases consultation in managing unexplained bacteremia.
- Early diagnosis and multidisciplinary management are key for favorable outcomes in complex cases.
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