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OBJECTIVES:
Q fever is caused by the bacterium Coxiella burnettii, an intracellular pathogen. Chronic infections are frequently associated with cardiovascular complications, usually endocarditis, but are also linked to aortic aneurysms and vascular graft infections. Rapid treatment of infection as well as surgical management of infections has been associated with improved outcomes. There has been a few reports of Q fever associated thoracoabdominal aneurysm including one treated with open repair using rifampin soaked polyester graft. Endovascular treatment of a thoracoabdominal aneurysm assocated with Q fever has not been described.
METHODS:
We present a case of a high risk patient that presented with a symptomatic 8.5 cm thoracoabdominal aneurysm, Crawford type III, caused by Q fever. Initially this patient had a small thoracoabdominal aneurysm discovered during a cardiac catheterization performed for acute myocardial infarction. She presented 18 months later with rapid enlargement of the aneurysm, abdominal pain and dysphagia. She had a several week history of weakness and fatigue but no fevers. Serologies were positive for chronic Q fever infection. Treatment consisted initially of antibiotic therapy begun preoperatively and continued postoperatively. The patient underwent endovascular repair using a surgeon-modified polyester stent-graft that was soaked in rifampin.
RESULTS:
The patient recovered from her procedure and was discharged post-operative day 9. A CT scan obtained 30 days post-operatively showed complete exclusion of the aneurysm with no endoleak, she remains pain free. She is to continue a prolonged course of oral antibiotics.
CONCLUSIONS:
The incidence of aneurysms related to Q fever is probably under-recognized. The diagnosis should be considered in cases of suspected mycotic aneurysms with negative cultures. Endovascular treatment of thoracoabdominal aneurysms with the addition long term antibiotics may be a viable treatment option for high risk patients.