Fulminant ruptured septic aneurysm complicating the catheter related blood stream infection in a patient on maintenance hemodialysis: A case report

Metastatic infections can complicate catheter-related blood stream infections (CRBSI) in dialysis dependent patients. However, an infected/septic aneurysm involving the aorta or its branches as a direct complication of CRBSI without an underlying infective endocarditis is not reported so far in the...

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Bibliographic Details
Published in:	The journal of vascular access Vol. 25; no. 5; pp. 1695 - 1699
Main Authors:	Veeranki, Vamsidhar, Prasad, Narayan, Sarda, Yashendu, Das, Abhraneel, Patel, Manas Ranjan, Kushwaha, Ravi Shankar, Meyyappan, Jeyakumar
Format:	Journal Article
Language:	English
Published:	London, England SAGE Publications 01-09-2024
Subjects:	Adult Aneurysm, False - diagnostic imaging Aneurysm, False - etiology Aneurysm, False - microbiology Aneurysm, False - therapy Aneurysm, Infected - diagnosis Aneurysm, Infected - diagnostic imaging Aneurysm, Infected - microbiology Aneurysm, Infected - therapy Anti-Bacterial Agents Aortic Aneurysm - diagnostic imaging Aortic Aneurysm - microbiology Aortic Aneurysm - surgery Aortic Rupture - etiology Aortic Rupture - microbiology Aortography Bacteremia - diagnosis Bacteremia - drug therapy Bacteremia - etiology Bacteremia - microbiology Blood Vessel Prosthesis Implantation - adverse effects Blood Vessel Prosthesis Implantation - instrumentation Catheter-Related Infections - diagnosis Catheter-Related Infections - drug therapy Catheter-Related Infections - microbiology Catheter-Related Infections - therapy Catheterization, Central Venous - adverse effects Catheterization, Central Venous - instrumentation Catheters, Indwelling - adverse effects Central Venous Catheters - adverse effects Central Venous Catheters - microbiology Computed Tomography Angiography Device Removal Female Humans Iliac Aneurysm - diagnostic imaging Iliac Aneurysm - microbiology Iliac Aneurysm - therapy Pseudomonas aeruginosa - isolation & purification Pseudomonas Infections - diagnosis Pseudomonas Infections - drug therapy Pseudomonas Infections - etiology Pseudomonas Infections - microbiology Renal Dialysis Treatment Outcome hemodialysis catheter related blood stream infection (CRBSI) Pseudomonas mycotic aneurysm Fulminant
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Summary:	Metastatic infections can complicate catheter-related blood stream infections (CRBSI) in dialysis dependent patients. However, an infected/septic aneurysm involving the aorta or its branches as a direct complication of CRBSI without an underlying infective endocarditis is not reported so far in the literature. We report a 43-year female, who presented with CRBSI 2 weeks following a tunneled dialysis catheter (TDC) insertion. Due to the lack of defervescence after 72 h of antibiotics given as per the culture sensitivity reports, the TDC was removed. Blood cultures grew Pseudomonas aeruginosa. After a catheter free interval of 4 days, a TDC was reinserted, an antibiotic course was completed, and she was discharged in stable condition. Five days later, she presented with acute abdominal pain and fever. A tender, firm, and pulsatile mass was noted in the hypogastrium with a bruit. Contrast-enhanced CT revealed a pseudoaneurysm of the aorta, and left common iliac artery at the site of origin. She was started on IV antibiotics and planned for an endovascular prosthesis but had a sudden collapse during her hospital stay due to a ruptured aneurysm. CRBSI due to certain pathogens such as Pseudomonas might require prolonged and dual antibiotic therapy to prevent fulminant complications.
Bibliography:	ObjectType-Case Study-2 SourceType-Scholarly Journals-1 ObjectType-Feature-4 content type line 23 ObjectType-Report-1 ObjectType-Article-3
ISSN:	1129-7298 1724-6032 1724-6032
DOI:	10.1177/11297298231192239