Mycotic Aneurysm Following Renal Transplantation: A Rare Complication Linked To Contaminated Preservation Fluid- A Case Report.

Mycotic pseudoaneurysms are rare yet potentially fatal complications following kidney transplantation, typically associated with infection and high morbidity. This report describes the case of a 66-year-old man who developed a mycotic pseudoaneurysm 4 months after a second renal transplant. The clinical course was notable for initial contamination of the preservation fluid with carbapenemase-producing Klebsiella pneumoniae, followed by delayed onset of symptoms and vascular complications. Despite early antimicrobial treatment and apparent graft stability, the patient later presented with graft dysfunction, low back pain, and systemic signs of infection. Imaging revealed a saccular pseudoaneurysm of the left iliac artery causing compression of the renal vein and ureter. Given the suspicion of a mycotic origin, endovascular exclusion of the pseudoaneurysm was performed using a covered stent, in conjunction with a femoro-femoral bypass. Targeted antibiotic therapy was administered for 6 weeks. Remarkably, graft function improved post-intervention and remained stable at 1-year follow-up. This case underscores the importance of rigorous post-transplant surveillance, especially in patients exposed to infected preservation fluids. It also highlights that, in selected cases, graft-preserving endovascular approaches may be successful alternatives to nephrectomy, even in the presence of infection. A multidisciplinary strategy combining individualized clinical judgment, targeted antimicrobial therapy, and minimally invasive intervention was crucial to the favorable outcome. This case contributes to the limited evidence supporting conservative management of infected pseudoaneurysms and emphasizes the need for ongoing clinical vigilance and tailored therapeutic approaches in immunocompromised transplant recipients.