Mycotic Hepatic Artery Aneurysm in Staphylococcus aureus Infective Endocarditis

We present the case of a woman in her 70s with a history of rheumatoid arthritis on long-term immunosuppression, previous breast cancer, and interstitial lung disease, who was admitted with fever, rigors, malaise, and gastrointestinal symptoms. Blood cultures grew Staphylococcus aureus, and echocardiography revealed a large aortic valve vegetation, confirming infective endocarditis. Later imaging identified discitis, bilateral renal infarcts, and a 3 cm hepatic artery aneurysm. During the course of treatment, she developed severe aortic regurgitation. She underwent hepatic artery embolization followed by tissue aortic valve replacement, and completed six weeks of intravenous antibiotics. At three-month follow-up, she was asymptomatic and had returned to normal daily activities. This case highlights the potential for disseminated embolic complications of S. aureus infective endocarditis, particularly in immunosuppressed patients, and underscores the importance of prompt multidisciplinary intervention to optimize outcomes.