Subject(s)
Deglutition Disorders/etiology , Empyema/complications , Empyema/microbiology , Esophageal Cyst/complications , Esophageal Cyst/microbiology , Esophageal Perforation/complications , Inflammation/etiology , Acute Disease , Anti-Bacterial Agents/therapeutic use , Comorbidity , Deglutition Disorders/diagnosis , Deglutition Disorders/epidemiology , Empyema/diagnosis , Endoscopy , Esophageal Cyst/diagnosis , Esophageal Perforation/diagnosis , Esophageal Perforation/surgery , Humans , Inflammation/diagnosis , Inflammation/epidemiology , Male , Middle Aged , Streptococcal Infections/drug therapy , Streptococcus intermedius/isolation & purification , Treatment OutcomeABSTRACT
Thoracic aortic wall disruptions may occur secondary to trauma, surgical interventions, infection, or autoimmune or idiopathic inflammatory disorders. Such vessel wall disruption can lead to aortic dissections, aneurysm development, or more commonly, pseudoaneurysm (PSA) formation. Although aortic wall infections as an antecedent to mycotic aneurysms have been recognized since the 17th century, there has been a temporal evolution in the development of this disease. Prior to the antibiotic era they were commonly associated with endocarditis or syphilis. More recently, however, they are associated with infection of a damaged atherosclerotic area of the aorta and secondary hematogenous or contiguous seeding. We report the first case of the rapid development of a pseudoaneurysm in the descending thoracic aorta attributable to an infection of a contiguous esophageal duplication cyst by a diagnostic esophageal ultrasound (EUS) fine-needle aspiration. A literature review of mycotic thoracic aortic aneurysms and pseudoaneurysms is also presented.
Subject(s)
Aneurysm, False/diagnosis , Aneurysm, Infected/diagnosis , Aortic Aneurysm, Thoracic/diagnosis , Aortitis/diagnosis , Esophageal Cyst/diagnosis , Aged , Aneurysm, False/microbiology , Aneurysm, False/therapy , Aneurysm, Infected/microbiology , Aneurysm, Infected/therapy , Anti-Bacterial Agents/therapeutic use , Aortic Aneurysm, Thoracic/microbiology , Aortic Aneurysm, Thoracic/therapy , Aortitis/microbiology , Aortitis/therapy , Biopsy, Fine-Needle , Blood Vessel Prosthesis Implantation , Debridement , Endoscopy, Digestive System , Endosonography , Esophageal Cyst/microbiology , Esophageal Cyst/therapy , Female , Humans , Lactobacillus/isolation & purification , Magnetic Resonance Angiography , Surgical Flaps , Tomography, X-Ray ComputedABSTRACT
Esophageal disease is a significant cause of morbidity among patients with the acquired immunodeficiency syndrome (AIDS). Many organisms have been implicated in the pathogenesis of dysphagia and odynophagia. We describe a unique presentation of actinomyces esophageal infection in two homosexual male patients with AIDS and biopsy proven CMV esophagitis. After failure of esophagitis to resolve with ganciclovir or foscarnet therapy, the patients underwent repeat endoscopy and were subsequently found to have a secondary infection of the ulcers by Actinomyces. Treatment with intravenous penicillin G resulted in symptomatic and histopathological resolution of esophageal disease. This appears to be the first report of Actinomyces infection of esophageal ulcers in AIDS patients, possibly a commonly overlooked diagnosis.
