Bacillus Calmette-Guérin related mycotic pseudoaneurysm in the aortic arch: clinical and surgical challenges

Mycotic aortic aneurysms following intravesical Bacillus Calmette-Guérin (BCG) therapy for urothelial carcinoma are rare but life-threatening. A male patient with BCG-treated bladder cancer presented with syncope, cough, and fever. Computed tomography showed a distal arch pseudoaneurysm, and positron emission tomography indicated infection. Treatment included aortic arch and descending aorta replacement and antimicrobials. Histopathology confirmed Mycobacterium bovis infection. The patient died one month postoperatively due to stroke and organ failure. Early recognition and multidisciplinary management are crucial.