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Aortic Graft Infection with Histoplasma capsulatum: A Case Report
John P. Davis MD, Amit Jain MBBS MS, Joshua C. Eby MD, John A. Kern MD, Gilbert R. Upchurch MD, Margaret C. Tracci MD JD
Introduction: Aortic graft infections remain a major clinical challenge for vascular surgeons. Typically, bacterial species such as Staphylococcus, Streptococcus, and enteric flora are implicated in these infections. Fungal infections have typically involved Candida or Aspergillus species. Reports of native vascular or graft infections involving Histoplasmosis capsulatum have been rarely reported in the literature.
Case Description: A sixty-year-old human immunodeficiency virus (HIV) negative male with prior infrarenal abdominal aortic aneurysm (AAA) repair presented to his primary care physician with back pain and hematuria. Computed tomography (CT) demonstrated multiple saccular aneurysms above and below his prior graft. The patient underwent wide resection of affected aortic tissue and reconstruction of visceral and infrarenal aortic segments with a rifampin-soaked, multi-branched polyester graft. Initial laboratory evaluation did not reveal leukocytosis and all blood cultures were negative. Intraoperative cultures revealed Histoplasmosis capsulatum in specimens including aortic thrombus, explanted graft, and aortic wall. Systemic antifungal therapy with liposomal amphotericin was initiated and subsequently transitioned to oral itraconazole for an anticipated 12-month course.
Conclusion: Aortic graft infections with Histoplasma capsulatum have rarely been reported in the literature. We describe an HIV negative patient with multiple saccular aortic aneurysms due to an aortic graft infection with Histoplasma capsulatum who was managed with resection of the infected graft and aortic wall, in-situ graft replacement, and combination antifungal therapy.