A Case of Iliopsoas Abscess and Cerebellum Abscess Caused by Misplacement of Central Venous Catheter

Abstract

A 64-year-old female was admitted due to iliopsoas abscess caused by misplacement of a central venous catheter (CVC) into the ascending lumbar vein (ALV). Despite removing the CVC and administering an antimicrobial agent, her general condition did not improve. Therefore, we performed a contrast-enhanced head computed tomography (CT) scan. The CT scan revealed a cerebellum abscess. Surgical cerebellum abscess drainage was thus performed urgently.We recommend using anteroposterior radiographs, J-guide wire catheter and ultrasound guidance to prevent misplacement. If misplacement of the CVC is suspected, it should be removed and a CT scan performed without hesitation as soon as possible.Keywords: catheter misplacement, iliopsoas abscess, cerebellum abscess, ascending lumbar vein Case Report A 64-year-old female had been undergoing nasal feeding due to anorexia nervosa and depression for about a year at another hospital. One day, she developed fever approximately three weeks prior to admission at our hospital. She was diagnosed with urinary tract infection and treated with an antibiotic. CVC was inserted from the right femoral vein. Her fever reduced temporarily, although her inflammatory reaction worsened progressively. She developed fever again two days prior to admission at our hospital. She had progressive disturbance of consciousness. She was brought to the emergency department of this hospital.She had a past medical history of atrial fibrillation. Initial vital signs were as follows: blood pressure of 116/83 mmHg, heart rate of 115 beats/min, respiratory rate of 15 breaths/min, SpO 2 of 97% on room air, body temperature of 36.7°C, and the Glasgow Coma Scale was E2V1M1 (total 4/15). Physical examination revealed edema in her entire body, while other system examinations revealed nothing in particular. Laboratory studies were as follows: white blood cell (WBC) count 43,410/µl, hemoglobin (Hb) 10.8 g/dl, and C-reactive protein (CRP) 19.13 mg/dl. Cerebrospinal fluid (CSF)