Kidney Week

Abstract: PUB062

Liver Abscess Complicating Tunneled Hemodialysis Catheter in a Patient with ESRD: A Case Report

Session Information

• Publication Only

Category: Dialysis

• 801 Dialysis: Hemodialysis and Frequent Dialysis

Author

• Nzerue, Chike, Meharry Medical College, Nashville, Tennessee, United States

Chike Nzerue, MD, MBA, FASN

Introduction

We report a 62 year old man with type 2 DM with HIV & ESRD on HD with TDC who developed, Staph aureaus bacteremia. IV antibiotics were begun . However, abdominal pain worsened and a CT showed a left lobe abscess. Intensive antibiotic therapy led to resolution after 4 weeks without drainage. Our case illustrates the need for rapid imaging of patients with TDCs who present with persistent symptoms after antibiotics and TDC replacement

Case Description

A 62 year-old black man with type 1 DM and HIV + for more than 20 years presented with abdominal pain and sepsis. .On examination, he appeared acutly ill, temperature was 97⁰F, BP 128/64, pulse of 96/min; respiratory rate of 22/min, oxygen saturation of 96% while breathing room air. Laboratory tests showed leukocytosis of 15,800/mm^3. TTE show no vegetations. Blood cultures showed MSS Staph aureas . Sepsis resolved with antibiotic X 4 weeks.

Discussion

Liver abcess, while a common complication in PD patients with abdminal sepsis,¹ is unusual in HD-associated bacteremia. Bacteremia is a well-known complication of TDCs.² . Persistent abdominal pain and leukocytosis after cathter exchange and antibiotic therapy was the reason to obtain the CT scan which showed the abscess. . Resolution of liver abcesses without drainage has been previously reported.³ The lesson of this case is that timely imaging is critical in manging persistenst symptoms in bactermic ESRD patients.
References.
1.Yang YF, Wang HJ, KanWC, et al. Pyogenic liver abscesses in ESRD patient undergoing dialysis.Am J Kid Dis2006;47(5)855-861
2. Tanriover B, Carlton D, Saddekni S, et al. Bacteremia associated with tunneled dialysis catheters: comparison of 2 treatment strategies. Kidney Int 2000;57(5):2151-2155
3.Wadhera S, Arora N & Dhibar DP. Modern Management of Liver abscess. J of Gastroenterol 2022;12086-093

Acknowledgment

We are thankful to the radiology department of our hospital for help with the CT images.