Infective endocarditis secondary to a hemodialysis catheter revealed by subarachnoid hemorrhage: Case report

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Published Jul 28, 2024
https://doi.org/10.62438/tunismed.v102i8.5022
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Vol. 102 No. 8 (2024): Tunis Med aug 2024

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Mahmoud Marzouk
National Institute of Neurology of Tunis, Anesthesia-Resuscitation Department,Tunis . University of Tunis El Manar , Faculty of Medicine of Tunis, Tunisia
https://orcid.org/0000-0002-9326-1503
Fathia Mghaieth
Cardiology department, La Rabta Hospital,Tunis. University of Tunis El Manar , Faculty of Medicine of Tunis, Tunisia
Nader Baffoun
National Institute of Neurology of Tunis, Anesthesia-Resuscitation Department,Tunis . University of Tunis El Manar , Faculty of Medicine of Tunis, Tunisia

Abstract

Introduction: Endocarditis associated with medical care is a rare and serious entity. The risk of occurrence is increased in hemodialysis patients due to the immunosuppression and the multiplicity of vascular accesses of different kinds. The mode of revelation can be variable given the diversity of symptoms it causes. Herein, we describe the case of endocarditis associated with medical care in a patient with renal failure who presents with neurological symptoms.


Observation: A 38-year-old patient with a history of kidney disease in the hemodialysis stage presented to the emergency room with altered neurological status in the context of fever. The patient's condition requires airway control, sedation, and vasopressor medication. Brain imaging revealed Fisher 4 subarachnoid hemorrhage with brain turgor. Transthoracic and transesophageal cardiac ultrasound exploration revealed infective mitro-aortic endocarditis with trigonal abscess fistulized in the left ventricle and destruction of the aortic valve with massive regurgitation. The additional imaging in a second step did not highlight any images of mycotic aneurysm. The indication for early surgery was not approved given the hemodynamic instability and the poor intracerebral hemodynamics demonstrated by transcranial doppler ultrasound. The initial outcome under antibiotic treatment and renal replacement was favorable. But the subsequent course was fatal due to septic shock with multiple organ failure.


Conclusion: The diagnosis of infective endocarditis should always be considered in hemodialysis patients presenting in a septic state with signs of systemic involvement. It is a source of mortality in these debilitated patients.

Keywords:

Case report, Catheter related infection, Endocarditis , Renal insufficiency, Subarachnoid hemorrhage, Transesophageal echocardiography

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