Can Atypical Mycobacterium Root Abscess In Immunocompromised Patient Be Successfully Treated?
Matthew Thomas, Cinthia Orlov, Oleg I. Orlov, Marios Kyriakos, Konstadinos Plestis.
lankenau medical center, Philadelphia, PA, USA.
OBJECTIVE: Mycobcaterium Avium Complex(MAC) usually affects immunocompromised patients and identified through blood cultures. We demonstrate a case of a root abscess in an immunocompetent individual, who underwent aortic root replacement for Type A aortic dissection.
METHODS: This is the case of a 55y.o. male who underwent a Bentall procedure for Type A Aortic Dissection in February 2015 at an outside institution. He had a ligation of the right coronary artery(RCA) and a saphenous venous graft(SVG) to the RCA. His postoperative course was complicated by acute renal and respiratory failure, cardiac arrest, and treatement for multiple wound infections. In April 2016, in a follow up CT scan a pseudaneurysm of the aortic root was diagnosed which was precipitated by dehiscence of the proximal anastomosis of the SVG to the Dacron graft. The blood cultures and a galium scan were negative. It was repaired with an Amplatzer Septal Occluder.
RESULTS: In August 2016,he was admitted with pancytopenia and high fevers. Blood cultures were negative and a bone marrow biopsy excluded hematologic causes. He was started on triple antibiotic regimen. His CT scan demonstrated a recurrent aortic root pseudoaneurysm,an occluded RCA and RCA vein graft. The patient underwent redo sternotomy, aortic root replacement with composite valve graft and reimplantation of the left coronary artery using Cabrol technique. SVG was used to bypass the RCA. The aortic arch was replaced and the brachiocephalic and left carotid arteries were reimplanted using a bifurcation graft. The patient was extubated on postoperative day two. On postoperative day eight MAC was identified both from the operative specimen and mediastinal drains. A MAC specific regimen was initiated. The patient was taken back to OR for washout and placement of an omentum flap. The rest of postoperative course was uneventful, he was discharged home and continues to do well in the 6 month follow up.
CONCLUSIONS: A MAC infection should be considered in a neutropenic patient with high fevers and negative cultures who underwent cardiac procedures in a recent past. A combination of medical therapy and aggressive operative resection of the infection is important to achieve cure in this patients.
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