unsuitable for the creation of an arterio-venous fistula (AVF) or implantable graft. A tunnelled dialysis catheter (Doublelumen PermCath) was inserted and haemodialysis commenced. Two months later he was admitted with pyrexia, rigors and a marked inflammatory response. He also complained of pain at the left sterno-clavicular joint. Repeated blood cultures, from separate sites, grew Staphylococcus epidermidis. Spiral CT scanning demonstrated evidence of osteomyelitis and clavicular destruction. The catheter was removed and peritoneal dialysis commenced. Antibiotic therapy with vancomycin and rifampicin was continued for a 6 week period with resolution of symptoms and inflammatory markers.Case 2. A 62-year-old Yemeni man presented to our emergency department with ESRF. Owing to symptomatic uraemia a tunnelled catheter was inserted and dialysis commenced. Three months later the patient developed high fevers, with raised inflammatory markers. Repeated blood cultures were negative. Despite replacement of the line and empirical antibiotic therapy he developed a shallow 4 cm ulcer at the catheter exit site. The catheter was removed, and the ulcer biopsied. The culture grew fully sensitive Mycobacterium tuberculosis. Clinical and radiological assessment found no other sites of tuberculosis. After initiating treatment and replacing the catheter, the ulcer healed and the patient improved.