Aspergillus Species as a Rare Cause of Primary Mycotic Aneurysm With Aortoenteric Fistula

Aortoenteric fistula (AEF) is an abnormal connection between the aorta and the adjacent gastrointestinal (GI) tract and is often misdiagnosed in clinical practice. We present the case of a 65-year-old male, who presented with upper GI bleeding and melena. The patient underwent upper and lower GI examinations with no conclusive findings. A computed tomography scan of the abdomen was suggestive of an AEF. The patient experienced a sudden episode of hematemesis with hemorrhagic shock in the ward, leading to an emergent surgery for bleeding control and repair of the aortic aneurysm and AEF with straight aortic interposition graft and primary repair of the duodenum along with debridement for whitish mycotic debris. A tissue culture from the aortic aneurysm during surgery revealed Aspergillus species infection. AEF is a life-threatening condition with high morbidity and mortality rates, often making it difficult to diagnose. Early surgical intervention is crucial to prevent a fatal outcome. Although rare, fungal infection should be considered in a primary AEF.