A Hybrid Approach in Treating a Mycotic Aneurism Caused by MRSA: A Case Report

BACKGROUND Mycotic aortic aneurysms (MAA) are rare but life-threatening infections of the arterial wall, characterized by rapid progression, a high risk of rupture, and poor outcomes. They most frequently occur in immunocompromised or chronically ill patients, including those with diabetes, renal failure, or on long-term hemodialysis. Early diagnosis and prompt multidisciplinary management are critical for improving survival. CASE REPORT We present the case of a 58-year-old woman with end-stage renal disease on hemodialysis via arteriovenous fistula, who was admitted with fever, gastrointestinal symptoms, and respiratory distress. Blood and pleural fluid cultures isolated methicillin-resistant Staphylococcus aureus (MRSA). Transesophageal echocardiography (TEE) and computed tomography angiography (CTA) identified a saccular aneurysm of the descending thoracic aorta, consistent with a mycotic aneurysm. Given the severity of the infection and the patient's hemodynamic instability, a hybrid approach was chosen, involving endovascular aneurysm repair (EVAR) followed by open thoracotomy for pleural debridement and empyema drainage. Despite targeted antibiotic therapy and surgical intervention, the patient developed massive intraoperative hemorrhage and refractory septic shock, ultimately resulting in death 4 days postoperatively. Intraoperative cultures of the aortic wall confirmed MRSA infection. CONCLUSIONS MAA is a diagnostic and therapeutic challenge with high morbidity and mortality, particularly in high-risk populations. Imaging modalities such as CTA and TEE are essential for early diagnosis. Management typically involves prolonged intravenous antibiotics and either surgical, endovascular, or hybrid repair. Despite aggressive treatment, the prognosis is poor, underscoring the need for further research to guide optimal treatment strategies and improve outcomes.