An Unintended Consequence

A CLINICAL PROBLEM-SOLVING article by Nasia Safdar from University of Wisconsin School of Medicine, Madison.
A 79-year-old man with a 5-month history of fatigue and 20-lb weight loss presented to his local physician. The patient also reported intermittent episodes of high temperature, night sweats, and chills. He was treated with a short course of ciprofloxacin, followed by a course of levofloxacin, for a presumed sinus infection, without improvement in his symptoms.
The patient's medical history was significant for coronary artery disease, gastroesophageal reflux disease, hypothyroidism, and transitional-cell cancer of the bladder, which had been diagnosed 4 years earlier and was currently in remission.
Two weeks after completion of antimicrobial therapy, the intermittent fever, fatigue, and night sweats persisted.
An evaluation for fever of unknown origin was undertaken.
CT of the abdomen and pelvis is recommended in patients with fever of unknown origin, and the most common finding is an abscess or lymphadenopathy. In this patient, the CT study revealed an infrequent cause of fever of unknown origin — namely, a likely mycotic aneurysm of the infrarenal aorta. Infected aneurysms of the aorta are rare but potentially catastrophic.
Urgent surgical intervention was warranted for the aneurysm.
A day after the surgery, the additional history was obtained. This lead to the final diagnosis.

「膀胱内BCG注入療法後の結核性腹部大動脈瘤の1例」も御参照下さい。