PMC5216144_01
Effects of antibiotics on fever and C-reactive protein during hospitalization. The patient finally became afebrile and has C-reactive protein levels within the normal range after receiving antibiotics. CRP: C-reactive protein, DAP: daptomycin, PCG: penicillin G, TAZ/PIPC: tazobactam/piperacillin, Tx: therapy
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She was initially diagnosed with PR3-ANCA-associated vasculitis and was thereafter treated with methylprednisolone pulse therapy (500 mg/day) for three days (Fig. 1). This additional antibiotic treatment made her afebrile again, and her renal function was recovered (Fig. 1).
Transesophageal echocardiographic images of the descending aorta, with sectioning planes at 90  (a) and 0  (b). Many oscillating masses attached to the intima were seen in the lumen of the descending aorta.
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Transesophageal echocardiography also revealed no vegetation in the heart; however, it showed many oscillating masses attached to the intima in the descending aorta (Fig. 2).
Contrast-enhanced computed tomographic images in the axial (a) and frontal (b) sections. These images show a descending aortic pseudoaneurysm and a contrast defect (arrow) beside the aneurysm that is compatible with echo-documented vegetation.
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Contrast-enhanced computed tomography (CT) revealed a new descending aortic aneurysm (Fig. 3).
A nontender hemorrhagic macular on the sole of the foot (a). Photomicrograph of the macular lesion shows microembolization with fibrin and infiltration of neutrophilic cells Hematoxylin and Eosin staining (b,c). These findings are compatible with a Janeway lesion.
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During the antibiotic treatment, she developed a Janeway lesion, which was confirmed by the pathological finding of a skin biopsy specimen (Fig. 4).
A transesophageal echocardiographic image of the descending aorta after the antibiotic treatment, with the sectioning plane at 90 . Many oscillating masses have disappeared.
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Transesophageal echocardiography finally demonstrated that the vegetation had disappeared after the antibiotic treatment (Fig. 5), but contrast-enhanced CT revealed that the aneurysm remained unchanged in form.
A contrast-enhanced computed tomographic image after endovascular stent graft repair. It shows a successfully occluded infected pseudoaneurysm.
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On the 54th hospital day, she underwent endovascular aortic repair (EVAR) of the aneurysm (Fig. 6) after confirmation that her CRP level was in the normal range and once blood cultures were consistently negative.