沙門氏菌感染造成感染性動脈瘤以老年人下背痛表現之案列報告

A Case of Mycotic Aneurysm due to a Salmonella Infection in an Elderly Patient with Low Back Pain

感染性動脈瘤是由於感染過程導致的血管性異常擴張。感染性動脈瘤具有危及生命的併發症，包括動脈瘤破裂、嚴重敗血症和局部主動脈周圍感染。在疾病的早期階段中，症狀通常是輕微及非特異性的。因此，早期診斷和治療感染性動脈瘤是困難的。應隨時考慮到這個診斷，尤其是對於具有感染性動脈瘤危險因子且無明顯感染病灶的發燒患者。

在這篇文章中，我們報告了一名由沙門氏菌感染引起的感染性動脈瘤病例，患者是一名78歲有飲酒史的男性，最初以發燒、發冷及下背痛症狀表現。治療過程包括最初的經驗性抗生素使用，以及在動脈瘤擴大後安排手術。後續也進行經動脈栓塞術(TAE)、移植支架置入、栓塞及股-股動脈血管繞道術。

由於提到的非特異性症狀，感染性動脈瘤的早期診斷具有挑戰性。感染性動脈瘤可能以類似尿路結石、腎膿腫或急性腸胃炎的症狀表現。因此，對於下背痛的老年患者，尤其是具有主動脈瘤危險因子的患者，應將感染性動脈瘤作為鑑別診斷。

 

Mycotic or infected aneurysms are abnormal dilatations of the vasculature due to an infectious process. Mycotic aneurysm possesses life-threatening complications, including aneurysm rupture, severe sepsis, and focal periaortic infection. Symptoms are usually mild and non-specific during the initial course of the disease. Thus early diagnosis and management of mycotic aneurysm might be difficult.

In this article, we report a case of mycotic aneurysm due to a Samonella infection in a 78-year old man with a history of alcohol consumption who presented with symptoms of fever, chills, and low back pain. Laboratory examinations showed evidence of infection, while abdominal computed tomography revealed a mycotic aneurysm prior to the iliac bifurcation with mild perifocal fat stranding. The management included initial empirical antibiotics, with subsequent surgical intervention arranged. Trans-arterial embolization (TAE) with graft stenting and embolization as well as femoral-femoral bypass were conducted after informed consent was obtained.

Early diagnosis of mycotic aneurysm is challenging due to the unspecific symptoms mentioned. An infected aneurysm may masquerade as urolithiasis, renal abscess or acute gastroenteritis in the elderly. Hence, mycotic aneurysm should always be considered as a differential diagnosis in aged patients with low back pain, especially in patients with predisposing aortic aneurysm risk factors.