Mycotic Aneurysm of Brachial Artery: A Rare Sequelae of Septicaemia

Abstract

Introduction: We present a rare case of brachial artery mycotic aneurysm caused by Staphylococcus Aureus. It is a potentially limb or life threatening condition1. Most cases described in literature are related to drug abuse, catheterization procedure or infective endocarditis. We would like to highlight an unusual complication of brachial artery mycotic aneurysm in arteriovenous fistula that was never been cannulated. Case Summary: 18 years old girl with end stage renal failure was referred from district hospital with impending rupture of left brachiocephalic fistula pseudoaneurysm which was yet to cannulate. She complaint of fever, redness, numbness and pain over left brachiocephalic fistula site for two days. Five months prior to current presentation, she was admitted for Methilin-Resistant Staphylococcus Aureus septicaemia complicated with parapneumonic effusion. Three months prior, left brachiocephalic fistula was created. Examination revealed a 5x5 cm pulsatile, tender mass with blistering skin over left cubital fossa. Ultrasound doppler confirmed a pseudoaneurysm over left brachiocephalic fistula. Patient underwent surgical exploration and repair. Intraoperatively, large pseudoaneurysm at the site of previous anastomosis line was found with pus collection. Overlying skin and pseudoaneurysm were excised en mass and arterial defect was repaired by transection and end-to-end anastomosis. A week post operation was complicated by brachial artery anastomosis dehiscence. She then underwent surgical exploration and ligation of left brachial artery. During hospitalization, multiple bedside debridement was done to aid in wound healing.  Intraoperative culture grew Staphylococcus Aureus which was sensitive to Cephazolin. Upon discharge, wound was healing, paresthesia improved and she was discharge with 6 weeks course of antibiotic. Discussion: It is important to recognize mycotic aneurysm of brachial artery. Early antibiotic and surgical intervention after a prompt diagnosis are essential to avoid further sequelae of infective endocarditis and mycotic aneurysm.