A 51-year-old male with long-standing ileocolic Crohn's disease, with multiple complications from sprouts and who required intestinal resection surgery with a terminal ileostomy in 2009.
This year HPN is started using a totally implanted intravascular device.
She was being treated with Infliximab and corticosteroids.
The following year she was admitted several times due to febrile syndrome associated with abdominal pain, without an evident focus and considering the origin the disease itself.
Staphylococcus epidermis was isolated in several hemocultives in these hospitalizations.
The catheter was also sutured due to rupture, removing only the reservoir and proximal portion of the catheter when the distal portion fixed to the tissue was found, so a fragment of the superior vena cava was lodged in the site.
In February 2011, she presented similar characteristics with fever of 11 days of evolution and abdominal pain that progressed to septic shock and was admitted to the ICU.
A chest X-ray showed that the abandoned fragment of the catheter was located from the superior vena cava to the right ventricle.
The study was completed with an echocardiogram, which showed vegetations on the catheter from the atrium to the ventricle.
With the diagnosis of catheter endocarditis, antibiotic treatment was initiated with Daptomycin and Rifampicin, taking into account previous isolations of Staphylococcus epidermis, and underwent cardiac surgery to remove both catheters.
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Initially the patient developed multiorgan dysfunction without control of the septic picture despite antibiotic treatment.
A CT scan of the skull and abdomen was performed to look for other foci of infection with the following findings: subarachnoid hemorrhage, patchy condensations in the right lung and several splenic infarcts, all compatible with emboli.
In the surgical specimen there were several isolates: Staphylococcus epidermis in the functioning catheter and polymicrobial growth in the catheter with vegetation.
In this case, Staphylococcus epidermis was isolated, Ochoderma longda as Trichorderma.
With these results the antibiotic treatment was modified leaving with Linezolid, Imipenem and Caspoline finally controlling the septic picture.
The patient had a torpid evolution requiring prolonged mechanical ventilation and stenosis, pneumonia associated with mechanical ventilation by Acinetobacter baumannii and polyneuropathy of the critical patient.
After a 45-day ICU stay, all these processes were resolved and the patient could be transferred to a facility where he completed his recovery.
