BACK PAIN REVEALING MYCOTIC ANEURYSM OF THE ABDOMINAL AORTA COMPLICATED WITH

Background: Mycotic aneurysm of the abdominal aorta is an uncommon disease that carries a high mortality rate. Its frequency among all aortic aneurysm has been reported as 0,5 to 1,3%. The authors report a case of mycotic aneurysm of the infrarenal aorta associated with pyogenic vertebral spondylodiscitis resulting from group C Streptococcus bacteraemia.Objectives: to remind rare but severe and urgent etiology of back painResults: A 71-year-old man with chronic lower back pain began to experience a severe pain and suffered from intermittent abdominal pain during two months before his visit. His body temperature was 38.5°C. Physical examination revealed tenderness on lower spine and right elbow arthritis. There was no evidence of infection of the oropharyngeal, respiratory, genitourinary, or skin system. Laboratory data were a white cell count of 6700/mm, a hemoglobin concentration of 10.6 g/dl, and a raised inflammatory tests with sedimentation rate at 106 mm and CRP at 33mg/l. Group C Streptococcus grew from cultures of blood. Radiographies revealed only degenerative lesion. Abdominal echography suspected abdominal aneurysm. Magnetic resonance imaging (MRI) revealed then a 5x4x6 cm infected abdominal aortic aneurysm invading the second lumbar disc and an abscess extending into the psoas. Cerebral MRI showed a thrombosis of the lateral cerebral sinus with left chronic mastoiditis, probably the source of infection. Echocardiographic examination revealed no evidence of vegetation on the heart. The patient underwent antibiotic therapy, associating penicillin G/gentamycin shifted to cefotaxim/ciprofloxacin for 10 weeks. A control MRI showed then the same lesions with partiel thrombosis of the aneurysm. He was operated with resection of the aneurysm, the infectious surrounding tissues and restoration of the flow using axillobifemoral bypass. The postoperative course was smooth, and the patient is well being until now after two months and a half post surgery. Antibiotherapy was maintained.Conclusion: Infected aortic aneurysm with vertebral osteomyelitis is a rare clinical entity. Prompt diagnosis and adequate treatment are essential. CT and MRI are beneficial in the identification and characterization of aneurysms.References: 1. Piccinato CE, Cherri J, Moriya T. Mycotic aneurysm of the abdominal aorta Rev Paul Med. 1990 Mar-Apr;108(2):52-6.2. Walsh DW, Ho VB, Haggerty MF Mycotic aneurysm of the aorta: MRI and MRA features. J Magn Reson Imaging. 1997 Mar-Apr;7(2):312-5.3. Chao TC, Chou WY, Teng HP, Hsu CJ Osteomyelitis of multiple lumbar vertebrae associated with infected aortic aneurysm: a case report. Kaohsiung J Med Sci. 2003 Sep;19(9):481-5.Citation: Ann Rheum Dis, volume 64, supplement III, year 2005, page 522Session: Back pain