ABSTRACT
Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
Subject(s)
Humans , Middle Aged , Anti-Bacterial Agents , Aortic Aneurysm, Abdominal , Aortic Valve Insufficiency , Bacteremia , Early Diagnosis , Endocarditis , Fever , Fistula , Groin , Magnetic Resonance Imaging , Mortality , Technetium Tc 99m Exametazime , TransplantsABSTRACT
Prosthetic vascular graft infection (PVGI) is a relatively uncommon complication of peripheral vascular surgery and although rare, is the most severe complication in reconstructive vascular surgery. The early diagnosis of this complication can reduce the mortality. We report a case of aorto-femoral bypass graft infection, which was diagnosed by Tc-99m HMPAO WBC scan, complicated with infective endocarditis. A 60-year-old man had been operated with aortofemoral bypass graft because of aortojejunal fistula due to abdominal aortic aneurysm. Nine months later, he was admitted with fever of two months' duration. On echocardiolography, aortic regurgitation and vegetation were observed, and then he was diagosed with infective endocarditis. He was treated with antibiotics for 6 weeks. Recurrent bacteremia of unknown origin persisted despite antibiotic therapy. Multiple microorganisms were separately isolated from the blood cultures. He complained of intermittent right groin pain. Imaging study (CT, MRI, US) showed no definite evidence of graft infection. However, Tc-99m HMPAO WBC scan demonstrated uptake in the aortofemoral bypass graft site. The patient underwent emergent aortofemoral graft removal with axillobifemoral bypass and right femoropopliteal bypass.
Subject(s)
Humans , Middle Aged , Anti-Bacterial Agents , Aortic Aneurysm, Abdominal , Aortic Valve Insufficiency , Bacteremia , Early Diagnosis , Endocarditis , Fever , Fistula , Groin , Magnetic Resonance Imaging , Mortality , Technetium Tc 99m Exametazime , TransplantsABSTRACT
Secondary amyloidosis is characterized by accumulation of an amorphous proteinous material in the various tissue and organs with infectious disease or inflammatory disease. Symptoms of the amyloidosis are variable according to the involved organs. Reactive amyloidosis of bladder in rheumatoid arthritis (RA) is a rare condition with hematuria in the most cases. However, we report two cases of patients with RA, who have frequency due to secondary amyloidosis of bladder without hematuria. Therefore secondary amyloidosis of urinary bladder should be considered as a possible cause of frequency in patients with long-term RA.
