Cases reported "Arteritis"

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1/9. A case of pulmonary arteritis with stenosis of the main pulmonary arteries with positive myeloperoxidase-antineutrophil cytoplasmic autoantibodies.

    A 53-year-old woman was referred to our hospital with the main symptoms of productive cough, fever and exertional dyspnoea. Chest X-ray revealed enlargement of the left hilar shadow and cavitary infiltration in the right upper lobe. 99mTechnetium-macroaggregated albumin (99mTc-MAA) perfusion scintigram showed complete hypoperfusion through the entire right lung. A pulmonary angiogram revealed stenotic lesions in the right and left main pulmonary arteries. Right cardiac catheterization showed an elevated right ventricular systolic pressure. There was no evidence of systemic arterial lesions nor vasculitis. The patient was positive for myeloperoxidase (MPO)-antineutrophil cytoplasmic autoantibodies (ANCA) (168 EU). The mycobacterium avium complex sputum culture was positive. The pulmonary stenotic lesions were surgically resected. The resected pulmonary arterial lesions were pathologically diagnosed as non-specific vasculitis. The cavitary lesion disappeared 6 months after the surgery. Two years after the surgery, although the MPO-ANCA level had decreased to 12 EU, stenosis of the pulmonary arteries reappeared. It is suggested that the patient became positive for MPO-ANCA in association with the mycobacterium avium complex infection, and that the presence of MPO-ANCA may not be related to the development of pulmonary stenosis of the main pulmonary arteries.
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2/9. arteritis due to Salmonella with aneurysm formation: two cases.

    Although arterial infection due to Salmonella is rare, it remains one of the most common causes of primary mycotic aneurysms. The presentation is one of sepsis, cultures positive for Salmonella and rapid expansion or rupture of the aneurysm. The authors' experience at victoria Hospital, london, Ont., includes two cases of aneurysms infected with Salmonella--one aneurysm of the aorta and the other of the common femoral artery. Both patients were treated by excision of the aneurysm, extra-anatomic reconstruction in an area remote from the infected field and long-term administration of appropriate antibiotics. One patient was alive and well 36 months after resection. The other died of multiple organ failure 10 days after resection. From a review of the English and French literature since 1948, 64 cases of abdominal aortic aneurysms infected with Salmonella were found; half of the patients survived the perioperative period. The diagnosis of mycotic aneurysm must be considered in any patient with an aneurysm and culture specimens positive for Salmonella. The authors favour wide debridement of the infected aneurysm with extra-anatomic reconstruction. This view is supported by a review of the literature. The appropriate antibiotic therapy is bactericidal rather than bacteriostatic.
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3/9. candida albicans arteritis transmitted by conservative liquid after renal transplantation: a report of four cases and review of the literature.

    BACKGROUND: Mycotic arteritis and/or aneurysms are infrequent complications of renal transplantation. They are mostly secondary to bacterial infection and rarely to candida albicans. We report four cases of mycotic arteritis due to C. albicans after renal transplantation but which have been inoculated during organ harvesting or conservation. methods: In all the four cases corresponding to two independent donors, C. albicans was isolated few days later in the systematic culture of the conservative liquid. We also review the clinical features and outcomes of 13 cases previously reported in the literature. RESULTS: In two cases, the diagnosis of fungal arteritis was confirmed only during autopsy after the patient's death due to massive bleeding. In the other two cases, the diagnosis was made on the arterial section of the anastomotic wall after detransplantation for massive bleeding for arterial leakage although an immediate antifungal treatment with fluconazole and caspofungin was given and was found to be inefficient. CONCLUSION: This is a serious complication of renal transplantation because it leads to graft loss in the majority of the cases and even to death in a few cases despite an efficient and rapid treatment. Routine fungal cultures of preservation media are important for early diagnosis and timely surgical interventions are life-saving.
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4/9. Mycotic (Aspergillus) arteritis resulting in fatal subarachnoid hemorrhage: a case report.

    A seventy-one year-old Japanese man suffering from carcinoma of the common bile duct died from subarachnoid hemorrhage secondary in intracranial mycotic arteritis (MA). Repeated cultures of the discharge from the draining tubes, the tip of intravenous hyperalimentation catheters, blood, sputum, and urine failed to grow any fungus. autopsy disclosed MA due to Aspergillus at the terminal portion of the right internal carotid artery close to the posterior communicating artery.
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5/9. Salmonella arteritis: a precursor of aortic rupture and pseudoaneurysm formation.

    Salmonella arteritis developed in three patients with subsequent arterial rupture and pseudoaneurysm formation. They had a one- to two-week history of chills and fever, and blood cultures were positive for salmonella. Pulsatile, tender abdominal masses developed in two patients with aortic infection while they were hospitalized. The third patient's femoral artery infection presented as a painful swelling behind the knee. Arteriography demonstrated large vessel rupture with pseudoaneurysm formation and allowed a planned operation in each case. The infected aortic aneurysms were totally excised, the aortic stump oversewn, and the retroperitoneum drained through the flank. Axillobifemoral grafts were constructed to bypass the infection area. Antibiotics effective against salmonella (ampicillin sodium, amoxicillin trihydrate, or chloramphenicol) were given for six weeks postoperatively. Allthree patients are alive without evidence of furhter infection. Recognition that microbial arteritis may be a complication of salmonella infections, particularly when Salmonella choleraesuis and salmonella typhimurium are cultured, will lead to earlier detection of vascular lesions.
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6/9. Retinal embolization from endocarditis.

    Arterial emboli, fragmentation of both the arterial and venous blood columns, and bilateral cherry red spot were seen in the fundus of a patient with progressive onset of visual loss. Initially, the patient, a 56-year-old housewife, was thought to have temporal arteritis. Her clinical condition worsened on steroids which was subsequently discontinued when 5 out of 6 blood cultures were reported positive. Showers of microemboli were responsible for her unusual fundus findings.
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7/9. Granulomatous angiitis. An unusual etiology of stroke.

    A 43-year-old man, who died five months after the onset of left-sided sensory deficit, had angiographical and pathological evidence of an angiitis confined largely to the distribution of the right middle cerebral artery. Histological examination identified this process to be intracranial noninfectious granulomatous angiitis. Although certain clinical and pathological features of this disorder overlap with other vasculitides which effect the central nervous system, the disease nevertheless retains sufficient individuality to warrant status as an entity, and should be considered in the differential diagnosis in adults with lesions which produce focal neurological deficits and signs of increased intracranial pressure. The definitive answer regarding an infectious etiology will come only from detailed culture studies of the affected vessels.
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8/9. Candida arteritis: are GI endoscopic procedures a source of vascular infections?

    A 53-year-old woman, 11 years after a renal transplant on chronic immunosuppression, presented with a sudden onset of a painless left groin mass. Ultrasound revealed a 3 cm common femoral artery pseudoaneurysm and a 3 cm saccular aneurysm of the infrarenal aorta. Operative repair was excision and patch angioplasty of the aortic aneurysm with internal iliac artery and interposition grafting of the femoral artery aneurysm with saphenous vein. Postoperatively, candida albicans was identified in the aortic and common femoral arterial cultures. Candida infections often occur in patients with impaired cellular immunity due to seeding from urinary tract infections, vascular catheters, or manipulation of the gastrointestinal tract. Our patient, without any prior history of a fungal infection, had undergone a colonoscopy 3 weeks earlier. Without any other possible source being identified, the proposed mechanism for fungal entry into the vascular system was via the gastrointestinal tract, with seeding from the portal venous system. The exact medical and surgical management of these patients remains undefined, and a transplant vascular registry is really needed. However, immunocompromised solid organ transplant recipients undergoing gastrointestinal endoscopic procedures may be at a greater risk for the development of subsequent septicemia. Further reports are really needed to confirm the possible need in these patients for both periprocedural antibiotic and antifungal prophylactic coverage.
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9/9. Fatal hemorrhage from rupture of the intracranial internal carotid artery caused by aspergillus arteritis.

    To the best of our knowledge, this is the first reported case of combined intracranial and extracranial hemorrhage due to aspergillus cerebral arteritis. knowledge of the imaging and the importance of early diagnosis and treatment are emphasized. A 78 year old man developed progressive right-sided visual impairment and diplopia. magnetic resonance imaging demonstrated a mass lesion located in the right orbital apex, with extension to the cavernous sinus and the right middle cranial fossa. cerebral angiography showed no aneurysmal dilatation. He was scheduled for transnasal biopsy. However, the patient died of massive epistaxis and intracranial hemorrhage. Postmortem examination revealed an aspergillus granuloma of the orbit and the skull base involving the intracranial and extracranial internal carotid artery. aspergillus fumigatus was identified by culture. The characteristic feature of the fungal infection is a low-intensity signal on T2-weighted magnetic resonance images. This finding may be useful in diagnosing fungal infection.
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