Early detection and staged treatment resolve E. coli-associated mycotic AAA with contained rupture

Mycotic abdominal aortic aneurysm (AAA), especially with contained rupture, is a rare and potentially fatal condition. While most cases are attributed to common pathogens like Salmonella or Staphylococcus aureus, Escherichia coli is an uncommon causative agent. This rarity makes diagnosis challenging and highlights a gap in understanding the full spectrum of infectious etiologies for AAA. Current standard-of-care for mycotic aneurysms typically involves aggressive antibiotic therapy and surgical intervention, but the optimal timing and approach can vary based on the pathogen and patient presentation.

A man in his early 60s presented with acute E. coli prostatitis and a prostatic abscess. During his evaluation, an abdominal ultrasound incidentally revealed a 3.8 cm infrarenal saccular AAA suspicious for contained rupture. This finding prompted further investigation with contrast-enhanced CT imaging, which confirmed focal aortic wall disruption without active extravasation. Initial treatment involved intravenous ceftriaxone and vancomycin to control the infection. After achieving infection stability, Endovascular Aneurysm Repair (EVAR) was performed using an Endurant II stent graft.

The patient initially presented with acute E. coli prostatitis and a prostatic abscess, confirming an active systemic infection. An incidental abdominal ultrasound identified a 3.8 cm infrarenal saccular AAA, prompting further diagnostic imaging. CT scans provided crucial confirmation, revealing focal aortic wall disruption consistent with a contained rupture, preventing immediate, life-threatening extravasation. Intravenous ceftriaxone and vancomycin were administered, leading to observed stability on serial imaging, indicating effective infection control. This allowed for a staged approach to intervention. > Following successful infection control, Endovascular Aneurysm Repair (EVAR) with an Endurant II stent graft was performed, resulting in an uneventful recovery. The patient completed targeted antibiotic therapy, achieving a favorable outcome, demonstrating the efficacy of early detection and a coordinated multidisciplinary management strategy for this rare presentation.