A Septic Foot Leading to a Mycotic Iliac Aneurysm

A mycotic aneurysm is an infected, focal dilatation of the arterial system that commonly develops in the setting of bacteraemia or septic embolization. Microbial inoculation of diseased arterial endothelium is the most common mechanism. There is limited evidence guiding the management of mycotic aneurysms which is often complex and requires individualisation. In this report, we describe the case of a 68-year-old male presenting with septic arthritis of his left first metatarsophalangeal joint. The patient had ongoing fevers despite debridement and appropriate antibiotic therapy. Further investigation demonstrated a 5.6cm left common iliac artery aneurysm with focal uptake on white cell scan. The patient subsequently developed back pain and an interval scan demonstrated widening of the aneurysm up to 6.7cm. The patient was taken to theatre for emergency excision and successful repair with a bifurcated Dacron graft despite a presumably infected surgical field. The patient had an uneventful recovery and was discharge on life-long antibiotics. This unconventional surgical management highlights the ambiguities surrounding mycotic aneurysm repair and the need for further research to determine a method of best practice.