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KMID : 0359920100290060829
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Korean Journal of Nephrology
2010 Volume.29 No. 6 p.829 ~ p.833
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A Case of Septic Pulmonary Embolism in an End-Stage Renal Failure Patient with Infected Arterio-venous Graft for Hemodialysis
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Kwon Oh-Kyung
Bae Hong-Jin
Jang Won-Ik
Chung Sa-Rah
Choi Dae-Eun
Na Ki-Ryang
Lee Kang-Wook
Shin Young-Tae
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Abstract
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Septic pulmonary embolism (SPE) is different from non-infectious thromboembolism in that it causes pulmonary arterial obstruction and inflammation by infectious emboli from various sources. There are increased risks of SPE in patients with chronic kidney disease because of decreased immunity and frequent venous puncture with the use of indwelling venous catheters or arterio-venous graft (AVG). However, SPE related with AVG infection in end-stage renal failure patient is very rare. Recently, we experienced a typical case of septic pulmonary embolism occurring in a 57-year-old man with infected AVG during hemodialysis. The patient had started hemodialysis 10 years ago due to diabetic end stage renal failure. Due to functional failure of the arterio-venous fistula, hemodialysis had been performed through an AVG on the upper left arm 3 years before admission. One week before admission, the patient complained of fever, chill, and painful swelling on the AVG site. Chest x-ray and computerized tomography showed variable sized multiple nodules and some cavity formation, suggestive of septic pulmonary embolism on both lung fields. Methicillin-resistant Staphylococcus aureus (MRSA) was identified from blood and wound culture studies. The AVG was removed along with continued use of vancomycin administration for 8 weeks. Complete clinical and radiological recovery was attained 2 months after initiation of antibiotic treatment.
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KEYWORD
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Sepsis, Pulmonary embolism, Blood vessel prosthesis, Arteriovenous fistula, Hemodialysis
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