A Case of Mycotic Pseudoaneurysm of the Brachial Artery after Infective Endocarditis

Abstract

Pseudoaneurysm of the brachial artery is uncommon, and is caused by trauma, iatrogenic factors and infection. We herein report a case of mycotic pseudoaneurysm of the brachial artery that occurred after resolution of Infective Endocarditis (IE). This case was a 77-year-old male, with a past medical history of multiple cerebral infarctions and subarachnoid hemorrhage (SAH) ruptured middle cerebral artery aneurysm one year ago, from complications of IE caused by Streptococcus agalactiae（Group B）. The aneurysm was resected and clipped, postoperative treatment with antibiotics was given for three months. He was discharged from the hospital after confirmation that blood culture was negative and the C-reactive protein (CRP) and peripheral white blood cell count was normalization. About one year after the operation, his right upper arm rapidly swelled without pain over one month. Computed tomography (CT) showed brachial aneurysm. The aneurysm was managed by resection and the brachial artery was reconstructed with his saphenous vein. This approach was taken because of expectations of rupture and embolism if conservatively observed. Histopathological findings showed that it was pseudoaneurysm and inflammatory cells around brachial artery. We diagnosed secondary mycotic pseudoaneurysm of the brachial artery after resolution of infective endocarditis from the histopathological findings and antibiotic treatment history.