Inverse paradoxical embolism in a patient on chronic hemodialysis with aortic bacterial endocarditis

Am J Kidney Dis. 1999 Aug;34(2):338-40. doi: 10.1016/s0272-6386(99)70364-1.

Abstract

We present a 45-year-old patient on chronic hemodialysis who suffered aortic endocarditis by Staphylococcus haemolyticus after bacteremia associated with a venous catheter, which was used temporarily during the maturing phase of a Cimino-Brescia arteriovenous fistula in the left forearm. Three weeks after starting antibiotic therapy, the patient suffered a septic pulmonary embolism. The catheter had been removed 4 weeks before the embolism. Thrombophlebitis of lower limbs, infection or thrombosis of the vascular access, and the involvement of right-sided cardiac structures were all discarded. We assumed that the pulmonary episode was probably a consequence of the paradoxical passage of embolic material, detached from the aortic valve, from arterial to venous circulation through the arteriovenous fistula.

Publication types

  • Case Reports

MeSH terms

  • Aortic Valve*
  • Arteriovenous Shunt, Surgical / adverse effects
  • Bacteremia / etiology
  • Catheters, Indwelling / adverse effects
  • Embolism, Paradoxical / etiology*
  • Endocarditis, Bacterial / etiology*
  • Heart Valve Diseases / etiology*
  • Humans
  • Male
  • Middle Aged
  • Pulmonary Embolism / etiology*
  • Renal Dialysis*
  • Staphylococcal Infections / etiology*