Mycotic aneurysms and death in a hemodialysis patient.
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.
Chang
Celeste Sharon
CS
Division of Nephrology, Department of Internal Medicine, Mackay Memorial Hospital and Nursing and Management College, Taipei, Taiwan.
Thajeb
Peterus
P
Chen
Han-Hsiang
HH
Wu
Chin-Jen
CJ
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
D000900:Anti-Bacterial Agents; D014640:Vancomycin