Version 2: Mycotic Aneurysms: Uncommon Pathogens and Treatment Conundrums

Introduction: Mycotic aneurysms, characterized by vessel wall dilation resulting from infections including bacteria, fungi, and viruses, are a rare yet severe consequence of systemic infections.These aneurysms, accounting for 0.6% of Western countries' aneurysms, carry a higher risk of rupture compared to uninfected conditions. While the femoral artery, aorta, and intracranial visceral arteries are commonly affected, pathogens causing mycotic aneurysms vary across regions. Diagnostic challenges arise from nonspecific symptoms such as fever, and discomfort. To prevent the substantial morbidity and mortality associated with mycotic aneurysms, timely identification and treatment are paramount. We present a case series highlighting mycotic aneurysms caused by some rare pathogens - Salmonella Paratyphi A, Streptococcus pneumoniae and Pseudomonas aeruginosa.

Materials & Methods: The case series involves three patients diagnosed with mycotic aneurysms due to unusual pathogens. We describe each patient's clinical presentation, medical history, physical examination findings, laboratory results, imaging studies, and the diagnostic process leading to the identification of the causative pathogens. 

Results: The first case depicts a 70-year-old male with a ruptured infra-renal abdominal aortic pseudoaneurysm caused by Salmonella Paratyphi A. The second case involves a 66-year-old male with a Streptococcus pneumoniae-associated descending thoracic aortic pseudoaneurysm. The third case pertains to a 70-year-old male with a ruptured descending thoracic aortic aneurysm into the esophagus due to Pseudomonas aeruginosa infection. Each case highlights unique clinical features, laboratory findings, imaging results, and the management approaches undertaken. 

Conclusion: Mycotic aneurysms, stemming from infections involving diverse pathogens, pose diagnostic challenges due to their nonspecific symptoms. Early identification and intervention are essential to mitigate the severe complications associated with these aneurysms. The presented cases underscore the need for a comprehensive approach to diagnosis and management, ensuring optimal outcomes for patients affected by mycotic aneurysms.