2014 Volume 23 Issue 7 Pages 993-996
Group B Streptococcus (Streptococcus agalactiae) causes sepsis in pregnant women and neonates. On the other hand, infected aneurysms caused by Streptococcus agalactiae are very rare. We report the case of a 65-year-old man with a Streptococcus agalactiae-infected aneurysm of the brachiocephalic artery who suffered several cerebral infarctions before surgery. The patient was admitted because of pain in his right shoulder and loss of appetite that persisted for a month. On admission, he had no fever. His white blood cell count was 11,000/μl and serum C-reactive protein level was 3.72 mg/dl. Echocardiography revealed moderate to severe aortic regurgitation, and no vegetation was detected. Two days after admission, he developed high fever. The infected aneurysm of the brachiocephalic artery (41 mm in diameter) was diagnosed by enhanced computed tomography, and blood cultures were found to be positive for Streptococcus agalactiae. He subsequently developed left hemiparesis. Magnetic resonance imaging revealed new multiple cerebral infarctions in the right cerebral hemisphere, and he was treated with antibiotics for an additional week. Thirteen days after admission, surgery was performed. Under cardiopulmonary bypass, deep hypothermia, and selective cerebral perfusion, the infected aneurysm of the brachiocephalic artery was resected and aortic arch replacement with a rifampicin-soaked Dacron graft and aortic valve replacement were performed. The graft was covered with an omentum flap. Pathological examination revealed no bacteria on the aortic cusps, although accumulation of histiocytes with multinucleated giant cells and neutrophils was observed, which was consistent with infective endocarditis. His postoperative course was uneventful. Intravenous antibiotics were continued for 6 weeks after surgery. The patient has remained asymptomatic for 8 months after surgery.
