Rupture of Renal Mycotic Aneurysm that Developed during the Treatment of Streptococcal Infective Endocarditis and Vertebral Osteomyelitis

A 50-year-old woman received two weeks of cefozopran and two weeks of imipenem for streptococcal endocarditis and vertebral osteomyelitis. Subsequently she received four weeks of oral levofloxacin and eight weeks of oral clarithromycin due to persistent elevation of C-reactive protein. Finally, she was admitted to our hospital due to massive hematuria. Abdominal CT showed rupture of an aneurysm in the right kidney and emergent coil embolization was performed. Multiple sets of blood culture grew Streptococcus oralis, and transthoracic echocardiography revealed vegetation at the aortic valve. Retrospective review of the abdominal images revealed the emergence of the aneurysm during the treatment.