Primary mycotic aneurysm.

SUMMARY Due to the nonspecific clinical findings and poor prognosis, early recognition is mandatory in mycotic aneurysms. After rupture, they are almost always fatal. The difficulty and importance on early diagnosis of primary mycotic aneurysm prompts the presentation of a case of mycotic aneurysm of the abdominaly aorta. The term of Mycotic Aneurysm, was introduced by the first time by Osler,' in 1885, to describe any aneurysm resulting from any infection process involving the arterial wall. In spite of the low incidence and the widespread use of antibiotics, mycotic aneurysms are still a serious threat to life.2 Due to the insidious onset, the diagnosis in generally only made after rupture or leakage had ocurred. The surgery is then made in a contaminated field with consequent failure of the graft and poor prognosis.3 Mycotic Aneurysms may be classified as secondary (result of an intravascular source of infection such as bacterial endocardites or contiguous infection) and primary (unknown or distant source of infection) .~ Those lesions without primary focus of infection may also be termed as cryptogenic.5 Since the advent of antibiotic therapy the incidence of the secondary aneurysms has decreased and the most of the mycotic aneurysms are now primary.2 Salmonelia are the most frequent pathogens organisms and Sta'phylococci and Pneu mococci are second in incidence.2 CASE PRESENTATION A 48 year old black f emale was admitted to the hospital complaining of diarrhea and fever for a week prior to admission. The diarrhea was watery and brown containing no blood or mucus. The fever (39°) was associated with shaking chilis. One day before the admission she had had a colicky pain in the left lower quadrant of the abdomen. In the meantime a pulsatile rnass was felt in the midline of the abdomen. The past history was significant for malignant hypertension with renal artery stenosis bilaterally and nephrosclerosis. She was on hemodialysis for 1,5 year. On examination the patient was slightly pale and prostated. ']le pulse was 96, the blood pressure 140/60 and the temperature 39° C. There was a diffuse abdominal tenderness and a round pulsatile masse of about 10 cm in diameter was papable in the midline of the abdomen.