Mycotic Aneurysm of the Ulnar Artery Secondary to Bacillus Calmette-Guérin Therapy for Bladder Cancer: A Rare Presentation of Hypothenar Hammer Syndrome

J Hand Surg Am. 2019 Oct;44(10):905.e1-905.e4. doi: 10.1016/j.jhsa.2018.12.001. Epub 2019 Feb 4.

Abstract

Mycotic aneurysms, especially those of the upper extremity, are rarely reported in literature. These aneurysms are caused by bacterial endocarditis and, therefore, are more commonly seen in patients who are in an immunocompromised state, including those requiring bacillus Calmette-Guérin (BCG) therapy for bladder cancer. Owing to the inevitable rupture of mycotic aneurysms, the standard treatment is surgical repair with appropriate secondary antibiotics. We present a unique case of a mycotic ulnar artery aneurysm following BCG therapy and repetitive hand trauma in a patient with bladder cancer that was successfully repaired with microsurgical techniques and secondary antibiotics.

Keywords: BCG therapy; bladder cancer; hypothenar hammer syndrome; mycotic aneurysm; ulnar artery.

Publication types

  • Case Reports

MeSH terms

  • Aged
  • Anastomosis, Surgical
  • Aneurysm, Infected / diagnosis
  • Aneurysm, Infected / etiology*
  • Aneurysm, Infected / surgery
  • BCG Vaccine / adverse effects*
  • Computed Tomography Angiography
  • Hand / blood supply*
  • Humans
  • Ischemia / etiology*
  • Male
  • Mycobacterium tuberculosis / isolation & purification
  • Saphenous Vein / transplantation
  • Syndrome
  • Tuberculosis / diagnosis
  • Urinary Bladder Neoplasms / drug therapy

Substances

  • BCG Vaccine