Lavinia-Oltita Bratescu
Diaverum Morarilor Nephrology,Romania
Title: Thoracic paravertebral abscess and secondary meningitis in hemodialysed patient – case presentation
Biography
Biography: Lavinia-Oltita Bratescu
Abstract
Background
Catheter-related infections – exit site, tunnel and bacteraemias are common complications and present high morbidity, mortality and costs. Bacteraemias are the most clinically important -potential to transform into sepsis. The prevalent CVC use in patients initiate HD has increased to ~25% while >80%, in some countries.
Materials and Methods
A 67-year-old woman, insulin-requiring diabetes, vascular lesions - by-pass aorto-coronary, left amputation, secondary hypertension, CKD stage 5 is HD initiated by right jugular tunneled CVC - 2016. The malfunctioning CVC is replaced in 2017. After 7 days appear: intens posterior chest pain, fever, absence of infection’signs at exit site, with suspicion of infectious discitis. RMN and CT spine scan have been highlighted paravertebral abscess T3-T5 in contact with right pleura, without neuro surgical indication. After 5 days of treatment with Vancomycin, Rifampicin si Ceftriaxone, febrile syndrome persists; the temporo-spatial disorientation and stiftness of the cervico-thoracic spine appear. LCR examination has put the diagnosis of positive Staphilococcus Aureus meningitis. 14 days of treatment with Linezolid 600mg/day, i.v., together with Vancomycin 500 mg i.v./ HD session and oral Rifampicina 600 mg/day - 6 weeks is initiated. The patient associates Clostridium Difficile diarrhea, treated with oral Vancomycin in lower doses and on alternate days. Evolution is clinically and paraclinically favorable – RMN and LCR cellularity.
Discussions
The case particularities – 1. Its complexity through the two relatively rare complications – paravertebral abscess and secondary meningitis in patient with many comorbidities and 2. Simultaneos administration of intravenous and oral Vancomycin for bacteraemia and Clostridium Difficile treatment.