Recurrent mycotic aortic aneurysm with Klebsiella bacteremia and superimposed strongyloidiasis

Mycotic aortic aneurysms are rare, representing <5% of all aortic aneurysms with limited epidemiological data. To date, there are only three case reports on mycotic aneurysm with Klebsiella pneumoniae infection including one case of recurrent infection. There are no case reports on mycotic aortic aneurysm in the setting of a Strongyloides stercoralis coinfection, a helminth associated with intravascular dissemination of enteric bacteria. Although an open repair strategy is considered a gold standard for the treatment of these aneurysms, there is some consideration for endovascular strategies in emergent scenarios. There is significant debate on the length of antibiotic treatment. Further, although in situ reconstruction is preferred, extra-anatomic revascularization such as axillobifemoral bypass may be warranted in the cases of extensive infection to allow complete resection of infected tissue. We report a unique case of recurrent mycotic aortic aneurysm with Klebsiella bacteremia and S. stercoralis coinfection managed with intrathoracic and intra-abdominal resection along with extra-anatomic axillobifemoral bypass.