Abstract
Hemodialysis catheters: An overlooked source of fibrin sheath endocarditis
Highlights
Infective endocarditis is defined as pathological evidence of microorganisms demonstrated by culture or histological examination of a vegetation, a vegetation that has embolized or intracardiac abscess alongside clinical evidence proposed by Modified Duke Criteria [1]
The most common presentation of this entity is the formation of fibrin sheath vegetation in the superior vena cava [7,8], that can be overlooked by transthoracic echocardiography (TTE) [6, 7, 9]
We report a case of a young female patient with end stage kidney disease on hemodialysis who presents with progressive dyspnea associated to a flu like illness who was initially admitted under the presumptive diagnosis of community acquired pneumonia and was later diagnosed with infective endocarditis secondary to a fibrin sheath vegetation
Summary
Infective endocarditis is defined as pathological evidence of microorganisms demonstrated by culture or histological examination of a vegetation, a vegetation that has embolized or intracardiac abscess alongside clinical evidence proposed by Modified Duke Criteria [1]. In the last decade and so, there are some cases reported [6, 7] among patients on hemodialysis with long term tunneled central venous catheters with associated. We report a case of a young female patient with end stage kidney disease on hemodialysis who presents with progressive dyspnea associated to a flu like illness who was initially admitted under the presumptive diagnosis of community acquired pneumonia and was later diagnosed with infective endocarditis secondary to a fibrin sheath vegetation. In view of the aforementioned findings on CT and blood cultures a transthoracic echocardiography was performed and a catheter on the right atrium was noted but no abnormalities associated to it were reported. 7cm vegetation was removed (Figure 4) from the superior vena cava and after six weeks of Cephalosporin therapy, resolution of symptoms was achieved
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