[Mycotic aneurysms and multiple peripheral embolisms in a patient with infectious endocarditis]

Sepsis from an infected cardiac valve can lead to bacterial seeding and destruction of the arterial wall with formation of a mycotic aneurysm. The natural history of these lesions is the rupture. We report the case of a 20 year old female who was admitted to our institution with massive mitral regurgitation and emboli of the central nervous system and both lower extremities. She underwent emergency valve replacement and then, staged treatment of her ischemic legs and multiple asymptomatic mycotic aneurysms: Superior mesenteric, right common iliac and left superficial femoral arteries. A splenectomy was required to treat a splenic abscess. An aneurysm of a peripheral branch of the middle cerebral artery was medically treated, demonstrating reduction in size on subsequent angiogram. She recovered uneventfully and remains asymptomatic after 20 months of follow up. The development of new diagnostic and therapeutic tools has led to a decrease of these complications during infectious endocarditis. However, in the patient with late diagnosis and symptoms in different territories, the mycotic aneurysm must be kept in mind to provide the patient with appropriate treatment.