bs_bs_banner
524
Letters to the Editor
complication might be the presence of lower back pain and feelings of discomfort (3). The dissimilarity might be the presence of hypotension, tachycardia, and decreasing hematocrit levels. A follow-up CT with or without contrast might be required to check for active bleeding after removal. In conclusion, late onset of common iliac vein perforation by temporal HD catheter is a rare, but lifethreatening complication. Nephrologists inserting temporal catheters in the femoral vein should keep in mind that this complication can happen especially in patients with delirium. Acknowledgments Conflict of interest: None to declare.
Kentaro Wada,1 Motoo Araki,2 and Yuko Wada3 Division of Nephrology and Dialysis, Department of Internal Medicine, Nippon Kokan Fukuyama Hospital, and 3Department of Internal Medicine, Central Hospital, Hiroshima, and 2Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Email: [email protected]
1
REFERENCES 1. Kukita K, Ohira S, Amano I et al. Guidelines of vascular access construction and repair for chronic hemodialysis. J Jpn Soc Dial Ther 2011;44:855–937. (In Japanese). 2. Oliver MJ. Acute dialysis catheters. Semin Dial 2001;14:432–5. 3. Sirvent AE, Enríquez R, Millán I et al. Severe Hemorrhage because of delayed iliac vein rupture after dialysis catheter placement: is it preventable? Hemodial Int 2012;16:315–9.
Septic Pulmonary Embolism Caused by Internal Shunt Infection Dear Editor, We report a case of septic pulmonary embolism (SPE) caused by internal shunt infection. Infections and infectious complications of vascular access remain a major cause of morbidity and mortality in HD patients. Metastatic infections complicate 22% of hemodialysis patients with bacteremia (1). SPE is a relatively rare disease caused by infective embolus from septicemia or generalized focus of infection, often resulting in occlusion of pulmonary artery. A female patient in her 50s was first diagnosed with hyperpiesia and renal dysfunction in 1990. TreatTher Apher Dial, Vol. 19, No. 5, 2015
ment with oral medication was started but renal dysfunction progressed. The surgery of internal shunt, a native arteriovenous fistula, was done and hemodialysis was introduced in 1993. She had no past history of diabetic mellitus and her cause of renal dysfunction was thought to be benign nephrosclerosis. In September 2008, red flare at the internal shunt puncture site, swelling, and fever above 40°C were observed. Gram-negative bacilli were detected on blood culture. A diagnosis of shunt infection and septicemia was made, and treatment with 0.5 g/day of meropenem (MEPM) was started. Productive cough appeared, and chest X-ray and computed tomography (CT) showed multiple nodular shadows, and she was referred to our hospital for detailed examination and treatment. Leukocyte count was 9250/μL (3300–8800/μL) with markedly amplified percent of neutrophils (93%). C-reactive protein (CRP) level was also high at 19.7 mg/dL (
524
Letters to the Editor
complication might be the presence of lower back pain and feelings of discomfort (3). The dissimilarity might be the presence of hypotension, tachycardia, and decreasing hematocrit levels. A follow-up CT with or without contrast might be required to check for active bleeding after removal. In conclusion, late onset of common iliac vein perforation by temporal HD catheter is a rare, but lifethreatening complication. Nephrologists inserting temporal catheters in the femoral vein should keep in mind that this complication can happen especially in patients with delirium. Acknowledgments Conflict of interest: None to declare.
Kentaro Wada,1 Motoo Araki,2 and Yuko Wada3 Division of Nephrology and Dialysis, Department of Internal Medicine, Nippon Kokan Fukuyama Hospital, and 3Department of Internal Medicine, Central Hospital, Hiroshima, and 2Department of Urology, Okayama University Graduate School of Medicine, Dentistry, and Pharmaceutical Sciences, Okayama, Japan Email: [email protected]
1
REFERENCES 1. Kukita K, Ohira S, Amano I et al. Guidelines of vascular access construction and repair for chronic hemodialysis. J Jpn Soc Dial Ther 2011;44:855–937. (In Japanese). 2. Oliver MJ. Acute dialysis catheters. Semin Dial 2001;14:432–5. 3. Sirvent AE, Enríquez R, Millán I et al. Severe Hemorrhage because of delayed iliac vein rupture after dialysis catheter placement: is it preventable? Hemodial Int 2012;16:315–9.
Septic Pulmonary Embolism Caused by Internal Shunt Infection Dear Editor, We report a case of septic pulmonary embolism (SPE) caused by internal shunt infection. Infections and infectious complications of vascular access remain a major cause of morbidity and mortality in HD patients. Metastatic infections complicate 22% of hemodialysis patients with bacteremia (1). SPE is a relatively rare disease caused by infective embolus from septicemia or generalized focus of infection, often resulting in occlusion of pulmonary artery. A female patient in her 50s was first diagnosed with hyperpiesia and renal dysfunction in 1990. TreatTher Apher Dial, Vol. 19, No. 5, 2015
ment with oral medication was started but renal dysfunction progressed. The surgery of internal shunt, a native arteriovenous fistula, was done and hemodialysis was introduced in 1993. She had no past history of diabetic mellitus and her cause of renal dysfunction was thought to be benign nephrosclerosis. In September 2008, red flare at the internal shunt puncture site, swelling, and fever above 40°C were observed. Gram-negative bacilli were detected on blood culture. A diagnosis of shunt infection and septicemia was made, and treatment with 0.5 g/day of meropenem (MEPM) was started. Productive cough appeared, and chest X-ray and computed tomography (CT) showed multiple nodular shadows, and she was referred to our hospital for detailed examination and treatment. Leukocyte count was 9250/μL (3300–8800/μL) with markedly amplified percent of neutrophils (93%). C-reactive protein (CRP) level was also high at 19.7 mg/dL (
