Progression of Vascular Pythiosis and Management of Intra-Abdominal Arterial Involvement

Titi Saichuea; Nuttapon Susaengrat

doi:10.64387/tjs.2026.276589

Authors

Titi Saichuea Division of Vascular Surgery, Department of Surgery, Roi Et Hospital, Roi Et
Nuttapon Susaengrat Division of Vascular Surgery, Department of Surgery, Khon Kaen Hospital, Khon Kaen

DOI:

https://doi.org/10.64387/tjs.2026.276589

Keywords:

Intra-abdominal vascular pythiosis, Antifungal agent, Antibacterial agent

Abstract

Intra-abdominal vascular pythiosis is a rare, life- and limb-threatening infection caused by Pythium insidiosum. A 36-year-old Thai male with thalassemia presented with a chronic left leg ulcer that progressed despite debridement, leading to a below-knee amputation (BKA). Post-BKA, chronic osteomyelitis necessitated an above-knee amputation (AKA). The stump failed to heal, and intra-abdominal vascular pythiosis was diagnosed using PCR and computed tomography angiography (CTA), which revealed extensive arterial occlusion. Management included antifungal and antibacterial therapy, high AKA, and arterial resection. Over 36 months, the patient showed clinical improvement with stable inflammatory markers. Timely diagnosis of vascular pythiosis is essential for optimizing treatment outcomes, and radical surgical resection continues to serve as the cornerstone of effective therapy.

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