S Perloff, B Vahid
S Perloff, B Vahid. Pulmonary Septic Emboli and Pseudomonas Pneumonia: Complication of Hemodialysis Catheter. The Internet Journal of Nephrology. 2005 Volume 3 Number 2.
To The Editor,
A 33 year old woman was admitted to our hospital with fever, chest pain, and vomiting. Chest pain was pleuritic and was worse with inspiration. The patient was febrile for 6 days before evaluation. Her past medical history was significant for systemic lupus erythematosus (SLE), chronic renal failure on chronic hemodialysis, and hypertension. Physical examination showed temperature of 103°F, heart rate of 125/min, respiratory rate of 28/min, and blood pressure of 142/88 mmHg. The patient was ill-appearing and mildly tachypnic. Chest exam was remarkable for bilateral basilar crackles. Heart and abdominal exam were unremarkable. Mild erythema surrounding the right anterior chest wall venous catheter site was noted. Chest imaging studies during hospitalization are shown in figure1.
The venous catheter was removed. A sonographic study of right upper extremity showed a thrombus in right internal jugular vein. The catheter tip culture grew more than 100 colonies of
Risk factors for
Clinical manifestations are cough, purulent sputum, dyspnea, fever, confusion, and systemic toxicity. Chest radiograph usually shows multifocal airspace disease. Pseudomonal pneumonia mortality rate is high (70-80%). Poor prognostic indicators are old age, serious underlying condition, hemodynamic compromise, prior surgery, and broad-spectrum antibiotic therapy in 6 months prior to presentation. Antipseudomonal penicillins, penicillins plus β-lactamase inhibitor, antipseudomonal cephalosporins, aztreonam, carbapenems, and fluoroquinolones can be used in treatment of pseudomonal pneumonia1,3.
Bobbak Vahid, MD 1015 Chestnut Street Suite M-100 Philadelphia, PA 19107 Tel: 215 9556591 Fax: 215 9550830 E-mail: Bobbak.firstname.lastname@example.org