Bacillus Calmette-Guérin-Related Mycotic Pseudoaneurysm in the Aortic Arch: Clinical and Operative Challenges.

Mycotic aortic aneurysms following intravesical Bacillus Calmette-Guérin therapy for urothelial carcinoma are rare but life-threatening. A male patient with Bacillus Calmette-Guérin-treated bladder cancer presented with syncope, cough, and fever. Computed tomography showed a distal arch pseudoaneurysm, and positron emission tomography indicated an infection. Treatment included replacement of the aortic arch and the descending aorta and the use of antimicrobial agents. Histopathological analyses confirmed a Mycobacterium bovis infection. The patient died 1 month postoperatively of stroke and organ failure. Early recognition and multidisciplinary management are crucial. Clinical registration number: Ethics Committee of the Medical Faculty of RWTH Aachen (EK 25-341).