Introduction Mycotic aneurysms (MA) are rare but severe complications of infective endocarditis (IE), arising from septic emboli, bacteremia, or direct vascular invasion. Pulmonary artery involvement is particularly uncommon and presents a diagnostic and therapeutic challenge. Case Presentation We report the case of a 65‐year‐old woman with longstanding Type 2 diabetes mellitus, hypertension, and chronic kidney disease requiring dialysis, who developed native tricuspid valve IE due to methicillin‐susceptible Staphylococcus lugdunensis . She presented with multilobar pulmonary embolism and was initially treated with ceftaroline. Transthoracic echocardiogram revealed a 0.7‐cm tricuspid vegetation, and chest CT identified bilateral pulmonary artery pseudoaneurysms and acute emboli. Lumbar spine MRI revealed L4‐L5 spondylodiscitis without abscess, likely from hematogenous spread. Due to her age, comorbidities, and extensive bilateral pulmonary artery involvement, medical management was pursued with cephazolin and anticoagulation using unfractionated heparin followed by warfarin. She improved clinically and was discharged with outpatient follow‐up. Discussion This case highlights a rare instance of bilateral pulmonary artery MA as a complication of tricuspid IE. Although surgical and endovascular interventions are potential options, medical therapy alone may be effective in selected cases with appropriate antimicrobial and anticoagulant treatment. Imaging, particularly contrast‐enhanced CT, is essential for diagnosis and monitoring. Decision‐making must be individualized, often requiring multidisciplinary input due to the complexity and lack of standardized management guidelines. Conclusion Pulmonary artery MA is a rare, potentially life‐threatening manifestation of IE. Successful outcomes may be achieved with conservative therapy in selected patients, but optimal management requires a collaborative, case‐specific approach involving infectious disease, cardiology, surgery, and radiology teams.
Gutiérrez et al. (Thu,) studied this question.