Mycotic Aneurysm of the Ulnar Artery Presenting as a Late Complication of Fulminant Infective Endocarditis

We present a case of a mycotic ulnar artery aneurysm presenting after treatment for bacterial endocarditis. An 82-year man presented with back pain, a new heart murmur and hepatomegaly. A diagnosis of discitis and bacterial endocarditis was made. The patient was treated with benzylpenicillin and gentamycin. Two weeks after starting antibiotics he developed a fever and tenderness in his right forearm. The pain and fever resolved. A week later the pain returned, he became generally unwell and a pulsatile swelling developed in his right forearm. Ultrasound showed a 3 cm aneurysm of the ulnar artery. No other aneurysms were found. The aneurysm was resected and the inflow ligated. Despite appropriate antibiotic therapy, mycotic aneurysms may still develop secondary to fulminant infective endocarditis even after blood cultures have been sterile. © 2005 Elsevier Ltd. All rights reserved.