Successful Endovascular Repair of a Thoracic Infected Aortic Aneurysm with Concomitant Liver Abscess: A Case Report

BACKGROUND Concomitant infected aortic aneurysm and liver abscess is extremely rare and potentially fatal. Their simultaneous occurrence suggests an aggressive disease course and presents substantial diagnostic and therapeutic challenges. Because symptoms are often nonspecific, diagnosis is frequently delayed, which can lead to worse outcomes. Early recognition through timely imaging and a coordinated multidisciplinary approach are essential for optimizing clinical results. CASE REPORT A 65-year-old woman with a history of hypertension and diabetes mellitus presented with a 1-week history of epigastric pain, fever, and constipation. Laboratory studies showed leukocytosis and elevated inflammatory markers. Chest radiography showed an opacity in the left lower lung field. Contrast-enhanced CT demonstrated a focal aneurysmal dilatation of the descending thoracic aorta measuring 8.0×7.1×5.0 cm with an irregular wall and surrounding fat stranding, consistent with a mycotic aneurysm, and a hypodense hepatic lesion with peripheral enhancement, suggestive of a liver abscess. Empirical antibiotic therapy with piperacillin-tazobactam and vancomycin was initiated. Given the patient's and family's preference, comorbidities, and high surgical risk, thoracic endovascular aortic repair (TEVAR) was selected as the primary intervention. Blood cultures grew Klebsiella pneumoniae sensitive to piperacillin-tazobactam, prompting discontinuation of vancomycin. She improved steadily and was discharged after 40 days. Follow-up CT at 2 months showed no recurrence. CONCLUSIONS This case highlights the critical role of early imaging in detecting rare co-infections and supports TEVAR with targeted antibiotics as an effective, less invasive treatment for high-risk patients.