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Rhodotorula Mucilaginosa: A Rare Etiology Of Mycotic Aneurysm
Noah X. Dargy, M.D., Adrian Santini, MD, Hayden R. Caudill, DO, Ali Aburahma, MD.
Charleston Area Medical Center, Charleston, WV, USA.

DEMOGRAPHICS: Patient is a 63 year old male with a significant medical history of coronary artery disease, hypertension, hyperlipidemia and tobacco abuse. HISTORY: Our patient presented with two days of lower abdominal and flank pain, following a short course treatment as an outpatient for a urinary tract infection. On arrival to the emergency department, he was tender of his left upper and lower quadrants along the midline, and had an elevated CRP and a leukocytosis. Blood cultures and a CTA of the abdomen were obtained. Imaging demonstrated a degenerated juxtarenal aortic aneurysm with a possible pararenal fluid collection concerning for a mycotic aneurysm. CLINICAL COURSE: Patient was admitted and started on broad spectrum antibiotics with resolution of his abdominal pain. A multidisciplinary plan was developed, however the patient had recurrent pain on admission day two. An open retroperitoneal aortic aneurysm repair was performed with intra operative gram stain and tissue cultures. Dissection was challenging, and an aorta bi-iliac bypass was performed with rifampin soaked Dacron. Post operatively, the patient required re-exploration for a retroperitoneal hematoma and a left lower extremity angiogram for iliac stenting. On POD 3, initial blood cultures resulted positive for Rhodotorula mucilaginosa, and the patient was started on amphotericin B. The patientís clinical status continued to deteriorate with septic shock with imaging findings concerning for pneumonia and mycotic cerebral infarction. On post operative day 16 a family meeting was held in which they elected to proceed with comfort measures and transfer to a palliative facility. DISCUSSION: Mycotic aneurysms secondary to fungemia are infrequently described, and are predominately seen within patients that are both immunocompromised, or have had a primary source of infection. On further discussion with the patientís extended family, it was noted that he had received 10 months prior a left coronary catheterization from femoral approach with coronary stenting, which was unknown on admission, and over that time period, it was noted by his extended family that he had developed night sweats, malaise, and chills. This raises the concern that the aneurysm could have potentially been seeded from endovascular access, and lead to mycotic degeneration. Management strategies continue to favor open repair for most patients with extended antifungal treatment, however, complex endovascular repairs have been described as well.
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