A Case of Fungal Mycotic Abdominal Aortic Aneurysm with Candida albicans Sepsis

Yoshihiro Honda＊	Yukiyo Yoshida＊	Koji Kawago＊
Satoru Shiraiwa＊	Kenji Sakakibara＊	Shigeaki Kaga＊
Hiroyuki Nakajima＊

（Department of Surgery II, Faculty of Medicine, University of Yamanashi＊, Yamanashi, Japan）

Background:Fungal mycotic aneurysm is rare;however, special care and treatment are required for the deep fungal infection itself. Case:The patient was a 69-year-old man with a history of sepsis due to Candida albicans. He suffered from back pain and moderate fever. CT revealed saccular-form aneurysm at the infrarenal abdominal aorta. After emergent in situ bifurcated graft replacement of the infected aneurysm, antifungal treatment was attempted in reference to the antifungal drug sensitivity of C. albicans from intraoperative cultures and findings of fungal endophthalmitis in an ophthalmic examination. After an uneventful acute course, follow up CT images after 12 months postoperatively revealed pseudoaneurysm formation proximal to the site of graft anastomosis. Reoperation was planned with a trans-thoracic and transabdominal approach because of concerns about thoracoabdominal aortic infection. However, the reoperation displayed only inflammatory tissue around the graft and aortic tissue. Removal of the previous graft and reconstruction of the bilateral renal artery, and the pararenal abdominal aorta to the bilateral common iliac artery was performed. Intraoperative tissue cultures revealed no evidence of microorganisms. He returned home with oral antifungal treatment and is doing well at 8 months after the reoperation. Conclusions:Management of fungal mycotic aneurysms requires both surgical treatment and antifungal treatment. Antifungal agents should be selected based on the results of a susceptibility test and after examinations for metastatic comorbidities.

 

Jpn. J. Cardiovasc. Surg. 49:375-379（2020）

Keywords：aortic aneurysm;mycotic aneurysm;fungal infection;Candidiasis;antifungal treatment