Mycotic External Iliac Artery Aneurysm in a Child with Rheumatic Heart Disease and Infective Endocarditis

Abstract

Background: Mycotic aneurysms of the peripheral arteries are rare in children, especially in association with infective endocarditis (IE) secondary to rheumatic heart disease (RHD). Only a few cases of RHD with peripheral mycotic aneurysms have been reported in the literature, with none in the pediatric age group.

Case Presentation: We report a 10-year-old girl with known RHD and infective endocarditis who presented with acute onset left calf pain. Clinical evaluation and CT angiography revealed non-opacification of the left external iliac artery (EIA) with focal aneurysmal dilation suspicious for a mycotic aneurysm. Surgical exploration revealed a left EIA mycotic aneurysm requiring proximal and distal ligation and common iliac artery (CIA) to common femoral artery (CFA) bypass using autologous great saphenous vein.

Conclusion: This case highlights a rare but serious vascular complication of infective endocarditis in children. Early recognition and prompt surgical intervention can prevent limb loss and mortality.