Case Report
Hemodialysis catheters: An overlooked source of fibrin sheath endocarditis
Ismael Valle1, Miguel Colon2
1Department of Internal Medicine, San Juan City Hospital, Puerto Rico
2Department of Infectious Disease, Auxilio Mutuo Hospital, Puerto Rico

Article ID: 100890Z01IV2018
doi: 10.5348/100890Z01IV2018CR

Corresponding Author:
Ismael Valle,
MD, San Juan City Hospital, Bo.Monacillos,
San Juan PR 00936, Puerto Rico

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How to cite this article
Valle I, Colon M. Hemodialysis catheters: An overlooked source of fibrin sheath endocarditis. Int J Case Rep Images 2018;9:100890Z01IV2018


In recent years, healthcare associated infective endocarditis has shown an increasing trend most likely due to risk factor such as hemodialysis and diabetes. Staphylococcus aureus has become one of the most common causative organisms. We present the case of a 27-year Puerto Rican woman with diabetes mellitus and end stage kidney disease on hemodialysis who came to our Instruction with progressive dyspnea and a flu like illness with one week of evolution. Upon arrival to Emergency Department, a chest X-ray was performed revealing bilateral lung infiltrates and consolidates consistent with bilateral pneumonia. Empiric therapy for pneumonia was started but after seventy-two hours of antibiotic therapy patient continued deteriorating clinically. At that time, a chest computed tomography was performed, being remarkable for bilateral septic emboli and a large hyperattenuated lesion on the right atrium. Then, a transesophageal echocardiogram (TEE) was performed, since SVC and right atrium were unable to be properly assessed by transthoracic echocardiogram (TTE). The TEE revealed a large vegetation extending from superior vena cava to right atrial wall. Surgical management was then provided, in which a seven-centimeter vegetation was removed. Cephalosporin therapy was continued for six weeks leading to an uneventful recovery. Fibrin sheath formation secondary to hemodialysis catheter has become a frequent source of endocarditis that is overlooked by TTE. In view of the latter, we recommend TEE as the main approach to diagnose fibrin sheath endocarditis.

Keywords: Cephalosporin therapy, Infective endocarditis, Staphylococcus aureus, Transesophageal echocardiogram

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Author Contributions
Ismael Valle – Substantial contributions to conception and design, Drafting the article, Final approval of the version to be published
Miguel Colon – Substantial contributions to conception and design, Acquisition of data, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of Submission
The corresponding author is the guarantor of submission.
Source of Support
Consent Statement
Written informed consent was obtained from the patient for publication of this case report.
Conflict of Interest
Author declares no conflict of interest.
© 2018 Ismael Valle et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.