Turkish Journal of Thoracic and Cardiovascular Surgery - The possible role of Staphylococcus epidermidis in the development of pulmonary artery aneurysm in Behçet’s disease

Sep 26, 2026

A 35-year-old man with a five-year history of Behçet’s disease developed hemoptysis, dyspnea, intermittent fever, and chest pain while receiving immunosuppressive therapy delivered via a peripheral venous catheter for multisystem vasculitis. Imaging showed a large pulmonary artery aneurysm in the right upper lobe artery and a smaller left-sided aneurysm; inflammation markers were elevated and bacteriological tests were negative. After surgical removal, aneurysm fluid grew coagulase-negative staphylococcus (Staphylococcus epidermidis), and vancomycin was started. Following three weeks, leukocyte count and erythrocyte sedimentation rate improved, suggesting catheter access may have enabled infection leading to aneurysm formation.

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CategoryHealthcare

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CASE REPORT

Presentation and history

Imaging and laboratory findings

Treatment and outcome

Turkish Journal of Thoracic and Cardiovascular Surgery The possible role of Staphylococcus epidermidis in the development of pulmonary artery aneurysm in Behçet’s disease Behçet hastal›¤›nda pulmoner arter anevrizmas› oluﬂumunda Staphylococcus epidermidis’in olas› rolü Erkan Y›ld›r›m, Bülent Koçer, Tevfik Kaplan, Ünal Sak›nc› Department of Thoracic Surgery, Ankara Numune Training and Research Hospital, Ankara Pulmonary artery aneurysm (PAA) has dreadful consequences and is one of the leading causes of death in Behçet’s disease (BD). A 35-year-old male patient with a five-year history of BD had symptoms of hemoptysis, dyspnea, intermittent fever, and chest pain. He received immunosuppressive therapy for three months by peripheral venous catheterization because of general vasculitis involving the eyes, pulmonary vasculature, and neurological system. A chest X-ray showed a circular opacity obliterating the right hilum. Computed tomography of the thorax revealed a PAA, 74 mm in diameter, originating from the right upper lobe artery. Another PAA, 2-3 mm in size, was identified at the upper branch of the left pulmonary artery. White blood cell count was 12x106/ml, erythrocyte sedimentation rate was 67 mm/hr, and bacteriological analyses were all negative for bacteria. The PAA was removed by a right upper lobectomy. Bacteriological examination of fluid samples taken from the aneurysm pouch showed coagulase-negative staphylococcus (Staphylococcus epidermidis). Vancomycin was initiated according to the antibiotic sensitivity tests. After three weeks of antibiotherapy, leukocyte count was 7x106/ml, and erythrocyte sedimentation rate was 25 mm/hr. It was thought that peripheral venous catheterization might be responsible for the access of infectious agent, which then gave rise to the development of PAA. Key words: Aneurysm/surgery; Behcet Syndrome/complications; pulmonary artery/pathology; Staphylococcus epidermidis. Behçet’s disease (BD) is a multisystemic inflammatory disorder classified among vasculitides, affecting all types of blood vessels.[1] When it is associated with lesions in the large vessels, it is referred to as “vasculoBehcet’s disease” and includes venous or arterial occlusions and aneurysm formation. Systemic arterial manifestations of BD are less frequent compared with venous involvement, accounting for only 12% of vas- Pulmoner arter anevrizmas›n›n (PAA) çok kötü sonuçlar› vard›r ve Behçet hastal›¤›nda önde gelen ölüm nedenlerinden biridir. Beﬂ y›ld›r Behçet hastal›¤› olan 35 yaﬂ›ndaerkek hasta hemoptizi, dispne, intermitan ateﬂ ve gö¤üsa¤r›s› yak›nmalar›yla baﬂvurdu. Hastan›n üç ayd›r, gözleri, pulmoner damarlar› ve nörolojik sistemi tutan genelvaskülit nedeniyle, periferik ven yoluyla immünsupresiftedavi gördü¤ü ö¤renildi. Akci¤er grafisinde sa¤ hilusu oblitere eden sirküler opasite saptand›. Toraks bilgisayarl› tomografisinde sa¤ üst lob arterinden kaynaklanan, 74 mm çap›nda PAA görüldü . Ayr›ca, sol pulmoner arterin üstdal›nda, 2-3 mm çap›nda baﬂka bir PAA görüldü . Laboratuvar incelemelerinde, lökosit 12x106/ml, sedimantasyonh›z› 67 mm/sa olarak saptand›. Bakteriyolojik incelemeler bakteri varl›¤› aç›s›ndan negatif idi. Sa¤ üst lobektomi ile PAA baﬂar›l› bir ﬂekilde ç›kar›ld›. Anevrizma kesesindenal›nan s›v› örne¤inin bakteriyolojik takibinde koagülaznegatif stafilokok (Staphylococcus epidermidis) üredi. Antibiyotik duyarl›l›k testi sonuçlar›na göre vankomisin tedavisine baﬂland›. Antibiyotik tedavisinden üç haftasonra lökosit say›s› 7x106/ml’ye, sedimantasyon h›z› 25 mm/saat’e düﬂtü . Enfeksiyöz ajan›n giriﬂinden, periferik venöz kateterizasyonun, PAA’n›n geliﬂiminden de S. epidermidis’in sorumlu olabilece¤i düﬂünüldü . Anahtar sözcükler: Anevrizma/cerrahi; Behçet sendromu/komplikasyon; pulmoner arter/patoloji; Staphylococcus epidermidis. cular complications.[1] The pulmonary arteries are the second most common site of arterial involvement, preceded by the aorta. Pulmonary artery aneurysm (PAA)

FAQs

What symptoms did the patient present with?

He presented with hemoptysis, dyspnea, intermittent fever, and chest pain.

What did imaging show regarding pulmonary artery aneurysms?

Computed tomography revealed a 74 mm pulmonary artery aneurysm originating from the right upper lobe artery and a smaller 2–3 mm aneurysm in the upper branch of the left pulmonary artery.

How was Staphylococcus epidermidis identified and treated?

Fluid from the aneurysm pouch grew coagulase-negative staphylococcus (Staphylococcus epidermidis), and vancomycin was initiated based on antibiotic sensitivity tests.

Sep 26, 2026

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