INFECTIVE ENDOCARDITIS-RELATED BILATERAL SPONTANEOUS PNEUMOTHORAX IN A HAEMODIALYSIS PATIENT

Abstract

(MRSA) bacteraemia in another hospi-tal. Two months prior to this admission, he received implanta-tion of a cuffed tunnelled double-lumen catheter in the right jugular vein as the transient vascular access for haemodialy-sis. On the third day of this hospitalization, the haemodialysis catheter was removed under the impression of its related infection. Progressive shortness of breath developed and a chest radiograph showed a left-sided pneumothorax (Fig-ure1A, arrowheads) with progressive consolidation over the right upper lobe, which was absent 3 days before. A com-puted tomographic scan performed after chest tube insertion (Figure 1B) revealed incomplete expansion of the left lung as well as progression of multiple nodular infiltrations and sub-pleural cavities in bilateral lung fields (black arrows). These pulmonary cavities were caused by septic emboli originating from multiple vegetations over the tricuspid valve demon-strated by the transoesophageal echocardiography (Fig-ure 1C, white arrows). Spontaneous pneumothorax has long been recognized as a rare complication of tricuspid endocarditis (1), especially in intravenous drug abusers (2). Bacteraemia associated with tunnelled, cuffed haemodialysis catheters is relatively com-mon (3), and the prognosis of infective endocarditis in hae-modialysis patients is poor (4). The occurrence of persistent bacteraemia in haemodialysis patients using central venous catheter shall prompt the physician to search for possible catheter-related infections, and spontaneous pneumothorax may occur as a catastrophic complication.