title: Necrotizing fasciitis and infective endocarditis caused by Escherichia coli in a hemodialysis patient.
abstract: Patients with uremia are often immunocompromised and uremia patients undergoing maintenance dialysis are often vulnerable to uncommon infections. We report a 40-year-old man who was undergoing maintenance hemodialysis and was initially diagnosed with monomicrobal necrotizing fasciitis of the lower limbs, based on blood and pus cultures that yielded Escherichia coli. His condition improved after surgical debridement and antibiotic therapy. However, he eventually died of intracranial hemorrhage related to septic emboli. Concurrent infective endocarditis was diagnosed based on an echocardiogram that indicated vegetation in the left ventricular region. Escherichia coli-related necrotizing fasciitis and infective endocarditis is rarely seen in clinical practice. There should be a high index of suspicion for multiple infections when a hemodialysis patient presents with an uncommon infection.
authors.affiliation: Division of Nephrology, Department of Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Ming-Hsien
authors.initials: MH
authors.lastname: Tsai
authors.affiliation: Division of Nephrology, Department of Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Jyh-Gang
authors.initials: JG
authors.lastname: Leu
authors.affiliation: Division of Nephrology, Department of Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Yu-Wei
authors.initials: YW
authors.lastname: Fang
authors.affiliation: Division of Nephrology, Department of Medicine, Shin-Kong Wu Ho-Su Memorial Hospital, Taipei, Taiwan.
authors.forename: Shih-Chung
authors.initials: SC
authors.lastname: Hsieh
mesh_terms: D000328:Adult; D004696:Endocarditis / Q000628:therapy*; D004926:Escherichia coli / Q000254:growth & development*; D019115:Fasciitis, Necrotizing / Q000628:therapy*; D006801:Humans; D008297:Male; D006435:Renal Dialysis / Q000009:adverse effects*; D014511:Uremia / Q000209:etiology*
keywords: Escherichia coli; Hemodialysis; infective endocarditis; necrotizing fasciitis; uremia