Mycotic pseudoaneurysm: An unusual complication of coarctati
The present case has been reported in the European Heart Journal. A 3-year-old girl with no medical comorbidities presented with deterioration in her general condition since 2 weeks (fever and asthenia), history of prior hospitalization with possible diagnosis of atypical Kawasaki syndrome based on a prolonged fever of 39°C associated with cheilitis and cervical lymphadenopathy; therefore, the patient received human immunoglobulin and an anti-inflammatory dose of aspirin.

On Examination : Heart rate: 110 beats/minute, BP in the right upper limb was 139/83 mmHg and 99/71 mmHg in the right lower limb. Ix : CRP was 74 mg/L. The white cell count was 24000 giga/L with 85% of neutrophils.

Transthoracic Echocardiography (TTE) demonstrated a coarctation of the aorta. A cardiac CT-scan coarctation of the aorta complicated by pseudoaneurysm.

Emergency surgical treatment of this pseudoaneurysm and coarctation done. Microscopic examination of surgical specimens confirmed extra cardiac aortitis and bacteriological analysis revealed bacterial DNA (PCR RNA 16S), which tested positive for Streptococcus pneumoniae, fully sensitive to antibiotic therapy. After initial empirical antibiotic therapy, treatment targeted Pneumococcal infection with amoxicillin followed by a switch to ceftriaxone for a total of 6 weeks.

Learning points:

- Children with endocarditis often present non-specific symptoms and are less likely to have classical peripheral vascular and immunological phenomena, vegetation and Osler’s triad. Streptococcus pneumoniae is detected in 3–7% of cases of endocarditis in children and is thus a rare albeit often fatal infection

- Coarctation of the aorta may be complicated by mycotic pseudoaneurysm and Streptococcus pneumoniae (it is important to keep these rare complications in mind)

- The diagnosis of associated abscesses by transthoracic echocardiography is difficult or even impossible. The computed tomography scan was the key imaging tool for diagnosis and management when clinical history and echocardiography are unusual

- Combined medical and surgical treatment for pseudoaneurysm of an aortic coarctation may be lifesaving

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