A Septic Foot Leading to a Mycotic Iliac Aneurysm

A mycotic aneurysm is an infected, focal dilatation of the arterial system that
commonly develops in the setting of bacteraemia or septic embolization. Microbial
inoculation of diseased arterial endothelium is the most common mechanism.
There is limited evidence guiding the management of mycotic aneurysms which
is often complex and requires individualisation. In this report, we describe
the case of a 68-year-old male presenting with septic arthritis of his left first
metatarsophalangeal joint. The patient had ongoing fevers despite debridement
and appropriate antibiotic therapy. Further investigation demonstrated a 5.6cm
left common iliac artery aneurysm with focal uptake on white cell scan. The patient
subsequently developed back pain and an interval scan demonstrated widening
of the aneurysm up to 6.7cm. The patient was taken to theatre for emergency
excision and successful repair with a bifurcated Dacron graft despite a presumably
infected surgical field. The patient had an uneventful recovery and was discharge
on life-long antibiotics. This unconventional surgical management highlights
the ambiguities surrounding mycotic aneurysm repair and the need for further
research to determine a method of best practice.


Muhammad Shehzaad Peerbux, Daniel Thompson, Sophie Cerutti, Anna Ipkonmwosa and Hansraj Riteesh Bookun

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