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Mycotic aneurysm presenting as hip pain and severe anaemia

Mycotic aneurysm presenting as hip pain and severe anaemia
Mycotic aneurysm presenting as hip pain and severe anaemia
A 15-year-old boy with trisomy 21, moderate left atrioventricular (AV) valve regurgitation and a previously repaired AV septal defect developed Aerococcus urinae infective endocarditis. The infected left AV valve and surrounding tissue were surgically removed and replaced with a prosthetic mitral valve; this was followed by 6 weeks of intravenous antibiotics. Towards the end of his antibiotic course, his C reactive protein level began to rise, and he subsequently developed worsening hip pain and severe anaemia (Hb 3.7 g/dL). An ultrasound scan showed no hip joint effusion but incidentally identified an aortic aneurysm, confirmed by an abdominopelvic MRI scan. CT angiogram showed a large (14 cm) false distal aortic aneurysm with surrounding retroperitoneal haematoma (see figure 1A). Emergency repair of the aneurysm with an aorto-bi-iliac graft was performed. A day later, he developed an ischaemic right leg. CT angiogram showed an occluded right external iliac artery (EIA) (see figure 1B) with reconstitution of the right common femoral artery via collaterals with flow to the foot. Emergency vascular surgery revealed chronic dissection occluding the right EIA origin and an open patch plasty was performed. The patient recovered well.
pain, technology
0003-9888
Iro, Mildred A
8a5c81c4-0746-4f19-b1fc-7889d20e02eb
Jones, Christine E
48229079-8b58-4dcb-8374-d9481fe7b426
Faust, Saul N
f97df780-9f9b-418e-b349-7adf63e150c1
Wilson, Iain D C
8d91993c-2d78-488e-ac30-fe617584a3f9
Baxter, Stephen J
f2e7623e-e045-4a2a-a5f5-ec10204c2c6f
Pemberton, Mark
39d47e33-b6ca-4441-8019-8a39322bf0b6
Richens, Trevor
22f3d9d8-5adb-4a80-baf4-eddaadadcc4c
Patel, Sanjay Valabh
c41c0af2-414a-4d4c-afdb-e4b731635a25
Iro, Mildred A
8a5c81c4-0746-4f19-b1fc-7889d20e02eb
Jones, Christine E
48229079-8b58-4dcb-8374-d9481fe7b426
Faust, Saul N
f97df780-9f9b-418e-b349-7adf63e150c1
Wilson, Iain D C
8d91993c-2d78-488e-ac30-fe617584a3f9
Baxter, Stephen J
f2e7623e-e045-4a2a-a5f5-ec10204c2c6f
Pemberton, Mark
39d47e33-b6ca-4441-8019-8a39322bf0b6
Richens, Trevor
22f3d9d8-5adb-4a80-baf4-eddaadadcc4c
Patel, Sanjay Valabh
c41c0af2-414a-4d4c-afdb-e4b731635a25

Iro, Mildred A, Jones, Christine E, Faust, Saul N, Wilson, Iain D C, Baxter, Stephen J, Pemberton, Mark, Richens, Trevor and Patel, Sanjay Valabh (2021) Mycotic aneurysm presenting as hip pain and severe anaemia. Archives of Disease in Childhood. (doi:10.1136/archdischild-2021-321632).

Record type: Article

Abstract

A 15-year-old boy with trisomy 21, moderate left atrioventricular (AV) valve regurgitation and a previously repaired AV septal defect developed Aerococcus urinae infective endocarditis. The infected left AV valve and surrounding tissue were surgically removed and replaced with a prosthetic mitral valve; this was followed by 6 weeks of intravenous antibiotics. Towards the end of his antibiotic course, his C reactive protein level began to rise, and he subsequently developed worsening hip pain and severe anaemia (Hb 3.7 g/dL). An ultrasound scan showed no hip joint effusion but incidentally identified an aortic aneurysm, confirmed by an abdominopelvic MRI scan. CT angiogram showed a large (14 cm) false distal aortic aneurysm with surrounding retroperitoneal haematoma (see figure 1A). Emergency repair of the aneurysm with an aorto-bi-iliac graft was performed. A day later, he developed an ischaemic right leg. CT angiogram showed an occluded right external iliac artery (EIA) (see figure 1B) with reconstitution of the right common femoral artery via collaterals with flow to the foot. Emergency vascular surgery revealed chronic dissection occluding the right EIA origin and an open patch plasty was performed. The patient recovered well.

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More information

Accepted/In Press date: 2021
e-pub ahead of print date: 14 April 2021
Published date: 14 April 2021
Additional Information: Copyright: Copyright 2021 Elsevier B.V., All rights reserved.
Keywords: pain, technology

Identifiers

Local EPrints ID: 449556
URI: http://eprints.soton.ac.uk/id/eprint/449556
ISSN: 0003-9888
PURE UUID: 323b0bbf-6f1b-40c5-b6e7-2f624805bf92
ORCID for Mildred A Iro: ORCID iD orcid.org/0000-0002-9894-6149
ORCID for Christine E Jones: ORCID iD orcid.org/0000-0003-1523-2368
ORCID for Saul N Faust: ORCID iD orcid.org/0000-0003-3410-7642

Catalogue record

Date deposited: 07 Jun 2021 16:33
Last modified: 26 Nov 2021 03:16

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Contributors

Author: Mildred A Iro ORCID iD
Author: Saul N Faust ORCID iD
Author: Iain D C Wilson
Author: Stephen J Baxter
Author: Mark Pemberton
Author: Trevor Richens
Author: Sanjay Valabh Patel

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