Mycotic aneurysm with recurrent sepsis complicating post-transplant nephrectomy

A hypertensive 37-yr-old man underwent renal transplantation. The transplanted kidney was removed 5 days later, 21 mth before his death. He was maintained after transplantation by hemodialysis. His postoperative course was complicated by recurrent pseudomonal infection with bacteremia. He presented with symptoms of acute peritoneal irritation and hypovolemia followed by sudden death. Postmortem examination revealed that a saccular mycotic aneurysm of the left common iliac artery, at the site of the post-transplant nephrectomy, had ruptured into the peritoneal cavity. The case exemplifies postoperative mycotic aneurysm, the frequently obscure clinical findings of iliac artery aneurysms, and the need for a high index of suspicion of mycotic aneurysms in patients undergoing renal transplantation.