A rare complication of a hemodialysis tunneled catheter: Case report of a superior vena cava and right atrium candida endocarditis. (2020)

• Record Type: Journal Article
• Authors: Sousa, Mariana; Martins, Joana; Barreto, Sara; Santos, Cristina; Gouveia, Rita; Santos, José Paulo; Guerra, Nuno; Ramos, Aura
• Is Part Of: IDCases. Volume 20(2020)
• Publication Date: 2020
• Subjects: Candida albicans -- Endocarditis -- Tunneled cuffed catheters -- Hemodialysis; Communicable diseases -- Periodicals; Communicable Diseases -- Case Reports; Communicable Diseases -- Periodicals; Communicable diseases; Periodicals; 616.9
• DOI: 10.1016/j.idcr.2020.e00768
• Languages: English
• ISSNs: 2214-2509

Abstract

Highlights: There is a high rate of candidemia in hemodialysis patients, and consequently of Candida endocarditis. Candida endocarditis it´s a rare but frequently fatal complication of candidemia. To improve the prognosis of this condition a high index of suspicion is necessary for early diagnosis Early medical and surgical treatment could successfully treat patients with large vegetations. It is very important to do an effort to modify risk factors such us reducing hemodialysis catheters use. Abstract: Infections remain an important cause of death among hemodialysis patients. This population have a higher risk of candidemia. Candida endocarditis it´s a rare but frequently fatal complication of candidemia. A 64 year-old female presented with a purulent discharge at the insertion site of a hemodialysis tunneled cuff catheter. A catheter related bloodstream infection was suspected, cultures were obtained and wide-spectrum antibiotic therapy was administered. A multi sensitive Candida albicans was isolated. Transesophageal echocardiography showed a large vegetation located in the superior vena cava, in probable relation with a previous catheter. The first approach was antifungal treatment. Due to non-response, she did a surgical removal of the vegetation. Culture of the vegetation showed the same as the blood cultures. After one year she has no signs of relapse. To improve the prognosis of this high mortality condition a high index of suspicion is necessary for early diagnosis and timely intervention.