%0 Journal Article
%T Hepatic Artery Mycotic Aneurysm Associated with Staphylococcal Endocarditis with Successful Treatment: Case Report with Review of the Literature
%A Dhara Chaudhari
%A Atif Saleem
%A Pranav Patel
%A Sara Khan
%A Mark Young
%A Gene LeSage
%J Case Reports in Hepatology
%D 2013
%I Hindawi Publishing Corporation
%R 10.1155/2013/610818
%X Mycotic hepatic artery aneurysm is a vascular pathology associated with bacterial endocarditis. It is rare in occurrence after the introduction of effective antibiotics. We present a young patient with injection drug abuse associated staphylococcal endocarditis which was successfully treated with antibiotics and valve replacement who presented with abdominal pain. He was found to have mycotic aneurysm of hepatic artery which was successfully treated with coil embolization. 1. Introduction Hepatic artery aneurysm is an uncommon vascular lesion. Mycotic hepatic artery aneurysm is rare but recognized complication of bacterial endocarditis. The incidence of mycotic aneurysm has decreased following the widespread use of effective antibiotics. We present a case of hepatic mycotic aneurysm in a patient with staphylococcal bacterial endocarditis. 2. Case A 27-year-old male presented with complain of chest pain and abdominal pain. Patient had recent history of Methicillin Resistant Staphylococcus aureus (MRSA) aortic valve endocarditis and septic emboli to coronary arteries requiring double vessel bypass grafting with aortic valve replacement 5 months ago. He also had history of hepatitis C. He denied dyspnea, orthopnea, paroxysmal nocturnal dyspnea, fever, or chills. He also denied melena, hematochezia, or change in bowel habits. He had previous history of smoking and self-injecting drug abuse. Family history and review of system were unremarkable. Physical exam was significant for systolic heart murmur 3/6 in intensity, otherwise unremarkable systemic examination. His home medicines included aspirin, carvedilol, plavix, lisinopril, and sertraline. Laboratory data revealed white blood cell count (WBC) 10.5/L, potassium (K) 3.1£¿meq/l, total bilirubin 0.5£¿mg/dL, aspartate transaminase/alanine transaminase 12/10£¿IU/L, and alkaline phosphate level 75£¿U/L; urine drug screen positive for cannabinoids; chest X ray: no acute lung process; electrocardiogram (EKG): no acute ST-T changes. The patient was admitted to rule out acute coronary event, and infectious disease was consulted for further treatment recommendation. Computed tomography (CT) abdomen/pelvis was ordered for unexplained abdominal pain which revealed possible hepatic pseudo-aneurysm and CT Abdomen/pelvis angiography revealed right hepatic artery aneurysm of 1.2 ¡Á 1.0£¿cm size with no flow distal to aneurysm and left hepatic artery aneurysm of 5 ¡Á 6£¿mm size (Figure 1). Patient underwent coiling and successful embolization with nine coils in right hepatic artery aneurysm and four coils in left hepatic artery
%U http://www.hindawi.com/journals/crihep/2013/610818/