Abstract
Prosthetic arteriovenous (AV) graft is the second most common vascular access of choice in hemodialysis patients. Rare complications of such grafts are increasingly seen due to rising population of patients on hemodialysis. Infections and thrombosis are the most common complications. Though metallic implants are known to cause hypersensitivity skin reactions, prosthetic AV grafts are rarely known to cause such kind of reactions due to inert nature of materials used in their preparation. We present a case of 54-year-old male who developed contact dermatitis after AV graft creation which was mistreated initially as infection.
Highlights
Contact dermatitis remains one of the leading skin diseases in the United States
Blood cultures were taken and drainage sample was sent for culture and sensitivity. His white blood cell (WBC) count increased to 13 000 and erythrocyte sedimentation rate was 45; on suspicion of AV graft infection he was started on vancomycin 1.25 g intravenously given after each hemodialysis session
AV fistulas are considered vascular accesses of choice in hemodialysis patients due to low morbidity and mortality and AV grafts are only second in option in terms of preference
Summary
Contact dermatitis remains one of the leading skin diseases in the United States. Patients on hemodialysis are sensitized to many allergens, making them a potential subject for delayed type of hypersensitivity reaction over time. A 54-year-old male with past medical history of end-stage renal disease on hemodialysis, hepatitis C, ischemic stroke, depression, and anxiety was brought to the emergency department with the complaints of fever (100.2°F) and increased surgical site pain in left thigh He underwent creation of a left superficial femoral artery to greater saphenous vein prosthetic AV graft 1 day prior to admission. His vitals were normal and white blood cell (WBC) count was 10 000/cumm The day, his left thigh wound pain and swelling worsened concomitant with erythema, tenderness, and purulent discharge. Blood cultures were taken and drainage sample was sent for culture and sensitivity His WBC count increased to 13 000 and erythrocyte sedimentation rate was 45; on suspicion of AV graft infection he was started on vancomycin 1.25 g intravenously given after each hemodialysis session. Due to abrupt onset of symptoms within hours after AV graft placement, the diagnosis of AV graft contact dermatitis was made
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