Discussion: typhoid fever. Clinical jaundice occur within first 2

Discussion: Apart from intestinal manifestations of
Salmonella typhi, numerous extra intestinal manifestations can occur including
involvement of the central nervous system (3–35%), cardiovascular system
(1–5%), pulmonary system (1–86%), bone and joints (<1%), hepatobiliary system (1–26%), genitourinary system (<1%).3 Aneurysm is focal dilatation of vessel wall. Infected aneurysm defined as an infectious break in the wall of an artery with formation of a blind, saccular out-pouching that is contiguous with the arterial lumen. The name mycotic aneurysm was coined by Osler to describe aneurysms associated with bacterial endocarditis to denote appearance of  fresh fungal vegetations of infected aneurysms. Majority of mycotic (infected) aneurysms are caused by bacterial infections (Staphylococcus spp and Salmonella spp).Most important Risk factors for development of mycotic aneurysm include arterial trauma immunosuppression , concurrent sepsis.4, Salmonella is reported in 15 - 24% of cases of mycotic aneuryms.5 Mycotic aneurysms most commonly seen in the intracranial arteries, visceral arteries and peripheral arteries, typically at arterial bifurcations.6 Isolated (solitary) involvement of Iliac artery resulting in mycotic aneurysm is rare. Salmonella is one of the rare causes of Iliac artery aneurysm(IAA).7 The symptoms of infected aneurysm include fever (77%) and abdominal or back pain (92%). Compressive symptoms1 caused by iliac artery aneurysm include hydronephrosis (ureter compression), edema of lower extremity (Iliac vein compression), painful defecation (colon compression), constipation (rectal compression) and paraesthesiae, lumbosacral pain, sciatic neuralgia (lumbar plexus compression). Complications include rupture, aneurysm related thrombosis and thromboembolism. 5-year rupture rates for IAA range from 14 to 70%.8 Salmonellosis in blood culture along with aneurysm causing compressive symptoms should raise the suspicion of mycotic aneurysm. MR Angiogram helps in localizing, demonstrating the size and extent of an aneurysm. CT angiography helps in diagnosing infected aneurysm by demonstrating specific features suggesting infection. Liver involvement is commonly observed in patients with typhoid fever. Clinical jaundice occur within first 2 weeks of febrile illness. Hepatomegaly and moderate raise of transaminases are common findings. Therapy of mycotic aneurysms include surgical resection of the aneurysm with a bypass graft in combination with at least 6 weeks of antibiotics. Surgical management involves wide debridement of the infected area and either immediate or staged revascularisation via an in situ bypass (ISB) graft, an Extra-Anatomic Bypass Grafting (EABG) such as an axillary-femoral or a femoral to femoral bypass. Extra-anatomic bypass 9 is the treatment of choice if patient is stable. CONCLUSION: Ruptured mycotic aneurysm of iliac artery along with severe hyperbilirubinemia is a rare extra intestinal presentation of salmonellosis. Infrequently we encounter these type of cases in our regular clinical practice. Such type of cases require diligent workup to arrive at a diagnosis. Early initiation of treatment increase chances of recovery in such cases.