Fig. 3.

Clinical course of the patient.

The patient was diagnosed with Listeria monocytogenes-infected aneurysm using the rapid diagnostic testing and the multidetector computed tomographic angiography finding, in addition to blood culture results within 24 h. Antibiotic therapy, using ampicillin was administrated on day 2 and blood pressure was well-controlled. There was no evidence of infective endocarditis or bacterial meningitis based on transthoracic and transesophageal echocardiography, and cerebrospinal fluid examination, respectively. Repeated blood cultures on day 6 tested negative for L. monocytogenes. In-situ Y-graft (Japan Lifeline Co.) placement with revascularization and omental implantation was performed on day 8. The isolate was consistent with L. monocytogenes serotype 4b, as determined using 16S rRNA gene sequencing and the GenBank Basic Local Alignment Search Tool (BLAST) analysis (www.ncbi.nlm.nih.gov/genbank/) (Identities 1441/1441, Gaps 0/1441, Score 2662bits). After three weeks of intravenous antibiotic therapy, the intravenous ampicillin was replaced with oral amoxicillin. Oral amoxicillin was discontinued on day 85 since all anastomoses remained patent without left hydronephrosis in the follow-up CT. The patient has remained disease-free without recurrence.