Author(s): Shafeedha Rashbi Karakulangara1, Rajan Joseph Payyappilly2
A 63-year-old male patient with diabetes mellitus, hypertension and chronic kidney
disease who has been undergoing haemodialysis thrice weekly developed fever
and shivering during haemodialysis for one week. He was doing haemodialysis
from elsewhere and presented to nephrology department of our hospital with the
same complaints. The patient had an intravenous catheter over left internal jugular
vein, which was placed one month back from elsewhere for doing haemodialysis.
He is a known case of diabetes mellitus and hypertension for the past ten years
and on regular medications.
On examination, the patient was moderately built and nourished, pallor was
present and icterus, cyanosis, clubbing, lymphadenopathy, oedema were absent.
His respiratory, cardiovascular, central nervous and gastro intestinal system
examinations were within normal limit. The patient was febrile (101?? F). pulse rate
- 98/min, blood pressure – 150/80 mmHg, respiratory rate - 20 cycles per minute,
fasting blood sugar - 140 mg/dl, Hb – 9 mg%, WBC count - 5600/μL. On local
examination, mild erythema was noted over his neck on intravenous catheter site
of left internal jugular vein. Other investigations were within normal limit. Human
immunodeficiency virus (HIV), HBsAg and hepatitis C virus (HCV) antibodies were
negative. The urine and sputum cultures were done to rule out any genitourinary
or respiratory system involvement. Both cultures yielded no pathogens.
The patient was treated with removal of internal jugular vein catheter, and a
femoral vein catheter was placed. Blood and tip of intravenous catheter were sent
to microbiology laboratory for culture and sensitivity testing. The patient was
empirically started on intravenous antibiotic vancomycin.