Mycobacterium chelonae sepsis associated with long-term use of an intravenous catheter for treatment of hyperemesis gravidarum. A case report.
BACKGROUND
Of the 1-2% of pregnant women who develop hyperemesis, the great majority are managed successfully with antiemetics and, when needed, short courses of parenteral medications. Only rarely will chronic parenteral therapy be necessary. Such therapy may be associated with significant complications.


METHODS
A 38-year-old woman, gravida 3, para 1, induced abortion 1, with a history of hyperemesis in her first pregnancy, developed recurrent hyperemesis at 9 weeks' gestation. After four admissions and a 5.45-kg weight loss at 12 weeks' gestation, a Groshong catheter was placed in the left subclavian vein. The patient was then managed with home droperidol infusions and intravenous hydration as needed. At 30 weeks' gestation she developed tender, erythematous nodules over her legs and right arm. Culture from a biopsy of the nodules grew Mycobacterium chelonae, as did the catheter tip. M chelonae is a ubiquitous, opportunistic, nontuberculous (atypical) mycobacterium. The patient responded slowly to clarithromycin. At 37 weeks she delivered a healthy, 4,080-g, male infant. Three months postpartum the nodules continued to resolve slowly on clarithromycin.


CONCLUSIONS
When chronic parenteral therapy is required for hyperemesis gravidarum, attention must be given to potential complications. Indwelling catheters should be removed as soon as possible.
Katz
V L
VL
Department of Obstetrics and Gynecology, Sacred Heart Medical Center, Eugene, Oregon, USA.
Farmer
R
R
York
J
J
Wilson
J D
JD
D000328:Adult; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D002405:Catheterization, Central Venous / Q000009:adverse effects*; D017291:Clarithromycin / Q000627:therapeutic use; D005260:Female; D006801:Humans; D006939:Hyperemesis Gravidarum / Q000628:therapy*; D009165:Mycobacterium Infections, Nontuberculous / Q000188:drug therapy / Q000209:etiology* / Q000473:pathology; D016926:Mycobacterium chelonae / Q000302:isolation & purification; D010288:Parenteral Nutrition; D011247:Pregnancy; D011256:Pregnancy Outcome; D016896:Treatment Outcome
D000900:Anti-Bacterial Agents; D017291:Clarithromycin