Peripherally inserted central venous catheters are associated with several complications. Thrombosis, catheter-related infection and phlebitis are well-recognized complications. However, septic thrombophlebitis is very rare. We describe a 44-year-old patient with heart failure who developed extensive septic thrombophlebitis of the right internal jugular, brachicephalic, facial veins and superior vena cava as a complication of prolonged use of a peripherally inserted central venous catheter that was inserted for dobutamine infusion. The catheter was displaced into the internal jugular vein by manipulation of the patient who used it for injection of illegal drugs. Blood cultures grew Citrobacter amalonaticus and Coagulase-negative Staphylococcus with the former growing more often making it the more likely causative agent. The patient was treated successfully with antibiotics and anticoagulation. To our knowledge Citrobacter amalonaticus has not been previously recognized to be associated with septic thrombophlebitis.

Hemophagocytic syndrome (HPS) is a potentially life-threatening complication of rheumatic disorders characterized by the infiltration of morphologically benign hemophagocytic macrophages in the bone marrow and in various other organs. It is known to be associated with several conditions, such as viral or bacterial infection, malignancies, and autoimmune diseases such as systemic lupus erythematosus (SLE) and adult onset Still's disease and less commonly with rheumatoid arthritis (RA). We report a case of a 59-year-old lady known to have SLE and RA who developed worsening anemia, thrombocytopenia, coagulopathy, renal failure and was diagnosed with hemophagocytic syndrome. In spite of aggressive supportive management, intravenous steroids and immunoglobulins, the patient eventually died due to intracranial bleeding. Although cases of HPS have been previously described in association with SLE or RA, this is the first case of HPS to our knowledge to be diagnosed in a patient who had both RA and SLE.