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Mycotic aneurysms of pulmonary artery in a young girl with sickle cell disease: A case report

Basheer Ahmed*, Mohammed Ageeli, Hannan Abdali, Mohammed Algathradi, Khadejah Al- Shahrany, Eman Almhgani, Ahmed Al-Bishri

Background: Mycotic aneurysms of Pulmonary artery (PA) are a rare entity, and furthermore it is very rare in pediatrics. Its association with infection, structural cardiac and vascular anomalies, vasculitis, and pulmonary hypertension has been noted. To our knowledge, this is the first reported case of mycotic aneurysms of pulmonary artery in a child with sickle cell disease (SCD).

Aim: To report a rare complication of mycotic aneurysms of pulmonary artery in a patient with SCD.

Case report: 10-year-old girl, with SCD presented with dental abscess and was treated in her local hospital, she subsequently went on to develop swelling around the neck, with difficulty in breathing and swallowing, she was, therefore brought to our hospital Emergency Room. She had neck ultrasound and subsequently urgent Computed Tomography (CT) scan which showed huge anterior neck collection with enhanced wall and air loculi seen within, extending up to superior vena cava. Later she had bloody aspirate in endotracheal tube, so CT scan of the chest was done which showed that there is aneurysms involving the right pulmonary artery with necrotizing pneumonia involving the right upper lobe and blood culture was positive for Streptococcus viridans and the pus culture was positive for Streptococcus milleri.

Discussion and conclusion: Pulmonary Artery Aneurysms (PAAs) are very rare findings in the pediatric population. The impressive size of the distal aneurysms and the occurrence in a pediatric patient are unique features of this case. Most mycotic aneurysms are secondary to endovascular seeding. Successful management of mycotic aneurysm of PA in pediatric patients consists of high clinical suspicion, prompt diagnosis, and initiation of the broad-spectrum antimicrobial therapy which covers all possible causative agents, surgical intervention and coil embolization by interventional radiologist.