title: Mycotic aneurysms and death in a hemodialysis patient.
abstract: A patient with newly diagnosed end-stage renal disease (ESRD) received a femoral catheter for hemodialysis (HD). Shortly thereafter he developed fever, and blood cultures grew methicillin-resistant Staphylococcus aureus. The catheter was removed and the patient was treated with both vancomycin and rifampin; however, blood culture positivity persisted. The cerebrospinal fluid showed sterile meningitis. Subsequent imaging studies demonstrated aortic valve endocarditis and multiple mycotic aneurysms that appeared to include the intra- and extracranial vessels. The patient eventually died from sepsis. This case illustrates the aggressive and invasive nature of systemic infection with S. aureus and underscores the high morbidity and mortality associated with infections related to HD catheters.
authors.affiliation: Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital and Nursing and Management College, Taipei, Taiwan.
authors.forename: Celeste Sharon
authors.initials: CS
authors.lastname: Chang
authors.forename: Peterus
authors.initials: P
authors.lastname: Thajeb
authors.forename: Han-Hsiang
authors.initials: HH
authors.lastname: Chen
authors.forename: Chin-Jen
authors.initials: CJ
authors.lastname: Wu
mesh_terms: D000208:Acute Disease; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D017544:Aortic Aneurysm, Abdominal / Q000382:microbiology*; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D016106:Methicillin Resistance; D008875:Middle Aged; D011654:Pulmonary Edema / Q000209:etiology / Q000628:therapy*; D006435:Renal Dialysis; D013203:Staphylococcal Infections / Q000188:drug therapy / Q000209:etiology*; D014511:Uremia / Q000150:complications / Q000628:therapy*; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin