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A Case of Mycotic Aneurysm of the Abdominal Aorta Caused by Aspergillus fumigatus in a Tsunami Survivor After the East Japan Great Earthquake
Department of Infection Control and Laboratory Diagnostics, Internal Medicine, Tohoku University Graduate School of Medicine
Yuko FUJIKAWA, Yoshiaki GU, Kengo OSHIMA, Misa SOGI, Chihiro OE, Noriomi ISHIBASHI, Hiroaki BABA, Shinya INOMATA, Makiko YOSHIDA, Shiro ENDO & Mitsuo KAKU
(Received January 5, 2017)
(Accepted November 13, 2017)
Key words: mycotic aortic aneurysm, Aspergillus spp., tsunami lung

A 57-year-old male, who was nearly drowned by a tsunami following the East Japan Great Earthquake in March 2011, was referred to the vascular surgery team and infectious disease consultation of Tohoku University Hospital in October 2014, for a rapidly enlarging aneurysm of the abdominal aorta. The patient, who was previously healthy, developed pneumonia and a pulmonary abscess shortly after surviving the tsunami. He became disoriented 3 months later, MRI showed a brain abscess, and drainage with a ventriculo-peritoneal shunt was performed. He developed an abscess of thoracic wall in January 2012 and itraconazole was administered. Forty-two months after the tsunami, a CT scan revealed rapidly enlarging aneurysm of the abdominal aorta, suggesting a mycotic aneurysm, and the patient was referred to our hospital. The aneurysm was surgically removed and replaced with a Y-graft. Although blood culture and culture of the aneurysm removed showed no specific finding, pathological specimens showed necrotizing granulomatous inflammation, filled with filamentous fungi, which was genetically identified as Aspergillus fumigatus. We presume that A. fumigatus, usually unlikely to cause invasive infection in immunocompetent hosts, had been inhaled on the occasion of near-drowning, which caused bloodstream infection, involving the brain, soft tissue, and the abdominal aorta. This is, to our knowledge, the first report of a mycotic aneurysm of the aorta in a tsunami survivor caused by filamentous fungi.

[ Kansenshogaku Zasshi 92: 138-143, 2018 ]

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