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Case Reports in Nephrology
Volume 2017 (2017), Article ID 9460671, 7 pages
https://doi.org/10.1155/2017/9460671
Case Report

Nephrologists Hate the Dialysis Catheters: A Systemic Review of Dialysis Catheter Associated Infective Endocarditis

1Department of Nephrology, Maimonides Medical Center, Brooklyn, NY, USA
2Department of Internal Medicine, Maimonides Medical Center, Brooklyn, NY, USA
3Department of Infectious Diseases, Maimonides Medical Center, Brooklyn, NY, USA

Correspondence should be addressed to Ankur Sinha

Received 27 December 2016; Accepted 7 March 2017; Published 20 March 2017

Academic Editor: Władysław Sułowicz

Copyright © 2017 Kalyana C. Janga et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

A 53-year-old Egyptian female with end stage renal disease, one month after start of hemodialysis via an internal jugular catheter, presented with fever and shortness of breath. She developed desquamating vesiculobullous lesions, widespread on her body. She was in profound septic shock and broad spectrum antibiotics were started with appropriate fluid replenishment. An echocardiogram revealed bulky leaflets of the mitral valve with a highly mobile vegetation about 2.3 cm long attached to the anterior leaflet. CT scan of the chest, abdomen, and pelvis showed bilateral pleural effusions in the chest, with triangular opacities in the lungs suggestive of infarcts. There was splenomegaly with triangular hypodensities consistent with splenic infarcts. Blood cultures repeatedly grew Candida albicans. Despite parenteral antifungal therapy, the patient deteriorated over the course of 5 days. She died due to a subsequent cardiac arrest. Systemic review of literature revealed that the rate of infection varies amongst the various types of accesses, and it is well documented that AV fistulas have a much less rate of infection in comparison to temporary catheters. All dialysis units should strive to make a multidisciplinary effort to have a referral process early on, for access creation, and to avoid catheters associated morbidity.