A 54-year-old female hemodialysis patient was admitted with fever, raised inflammatory markers (C-reactive protein 154 mg per liter), and neck pain. She had been dialyzing via a tunneled catheter for 5 months following the failure of her cadaveric renal transplant and had no suitable upper-limb vessels for fistula creation. Echocardiography revealed a mass in the right atrium, and magnetic resonance imaging confirmed the presence of a friable thrombus, associated with the tip of the tunneled line (Figure 1). Blood cultures grew methicillin-resistant Staphylococcus aureus, and lateral spine radiographs showed obliteration of the C5/6 joint space and vertebral erosion, consistent with vertebral osteomyelitis, due to metastatic infectious spread from the infected thrombus. Magnetic resonance imaging of the spinal cord confirmed these findings (Figure 2). Treatment was commenced with intravenous vancomycin and gentamicin, and the catheter was removed after 6 weeks of anticoagulation. Despite initial improvement in both symptoms and inflammatory markers, the patient died 6 months later because of recurrent methicillin-resistant S. aureus septicemia, related to vertebral osteomyelitis.
Figure 1.
Magnetic resonance imaging showing a friable thrombus (arrow) in the right atrium (RA). The left ventricle (LV) and aorta (Ao) are also labeled for orientation.
Full figure and legend (29K)Figure 2.
Magnetic resonance imaging of the cervical spine showing obliteration of the C5/6 joint space, with destruction of end plates, posterior displacement of the vertebral bodies, and compression of the spinal cord (arrow).
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