Multiple metastatic infections in a hemodialysis patient with untunneled internal jugular catheter

Abstract

We present an end-stage renal disease patient on dialysis with fever. The primary source was right internal jugular vein catheter which had metastatic infections in the body probably via an arteriovenous communication in a cavity in left lung. Patient had right psoas muscle abscess and a left kidney abscess. An (18) F-fluorodeoxyglucose-positron emission spectroscopy scan was done to find out left kidney abscess. A search of literature did not reveal many patients of psoas abscess secondary to infection of hemodialysis access.

Iliopsoas abscess as a complication of tunneled jugular vein catheterization in a hemodialysis patient

“…The primary infection sources were reported as femoral vein catheterization with local anatomical changes in the lumbar veins, adjacent acupuncture, discitis, enterocolitis, systemic amyloidosis, arteriovenous shunt infection, endocarditis, and diverticulitis . Remote catheter infection (as in the present case) as the cause of iliopsoas abscess is apparently rare, and only one recent paper reported iliopsoas abscess as a complication of internal jugular vein catheter infection; however, the causal relationship was uncertain because the culture results of catheter tip and abscess were inconsistent . Moreover, the pathogens causing this abscess in hemodialysis patients were mostly MRSA, and most patients had better outcomes after surgical intervention and medical treatment.…”

“…7 Remote catheter infection (as in the present case) as the cause of iliopsoas abscess is apparently rare, and only one recent paper reported iliopsoas abscess as a complication of internal jugular vein catheter infection; however, the causal relationship was uncertain because the culture results of catheter tip and abscess were inconsistent. 13 Moreover, the pathogens causing this abscess in hemodialysis patients were mostly MRSA, 7,10,11,13 and most patients had better outcomes after surgical intervention and medical treatment. Because no MRSA endocarditis sign was noted before vascular access insertion and catheter was thought to be vulnerable for MRSA infection, a hypothesis was that the primary source of infection in our case was the tunneled jugular catheter, and she developed MRSA endocarditis, and ultimately, a right iliopsoas abscess.…”

Bacterial meningitis and multiple abscess formation in the iliopsoas, erector spinae, and vastus lateralis muscle in a maintenance hemodialysis patient treated with continuous epidural anesthesia for herpes zoster-related pain control: a case report and review of the literature

“…Hence, further studies are necessary to determine whether the risk for epidural catheter-related infection in hemodialysis patients with active herpes zoster is higher than those without active herpes zoster. Psoas muscle abscess is a rare but lethal complication that is occasionally seen in hemodialysis patients [8][9][10][18][19][20][21][22][23][24][25][26][27][28]. Triad of the classical psoas muscle abscess consists of fever, pain, and limp [29].…”

“…A previous report showed that the prognosis of secondary psoas abscess is worse than primary psoas abscess, and unless open surgical drainage is performed, its prognosis is unacceptable [30]. Table 3 summarized the previous 22 reports including our case on psoas muscle abscess in hemodialysis patients [8][9][10][19][20][21][22][23][24][25][26][27][28]. The age of the patients ranged from 45 to 78 years.…”

“…Besides, dialysis patients have greater opportunities to receive various types of artificial medical devices for treatment and examination, catheterization for angiography and intravascular placement of catheters, and artificial grafts for dialysis access. These artificial devices greatly enhance the risk of deep organ infection including muscle abscess, frequently leading to disability and mortality in hemodialysis patients [6][7][8][9][10].…”