A case of non-valvular endocarditis in a hemodialysis patien
The incidence of infectious endocarditis (IE) is significantly higher for patients who are on chronic hemodialysis (HD) compared to the general population for a number of reasons. The present case has been reported in the journal IDcases.

A 54 year old male with a past medical history significant for end stage renal disease (ESRD), peripheral vascular disease, and coronary artery disease.

The patient recently had difficulty with his AV fistula for dialysis, so an Ash Split catheter had to be placed. This is a dual lumen catheter that is inserted by a transcutaneous route into the central venous circulation for dialysis access. The patient was initially admitted to the hospital for a right femoral artery to popliteal artery bypass.

Approximately 20 min after induction of anesthesia, his blood pressure tracings were lost, and a pulse could no longer be palpated. He was given 1 mg of intravenous epinephrine and return of spontaneous circulation was obtained. The anesthesia team obtained a transesophageal echocardiogram (TEE) in the operating room, which demonstrated a possible right atrial mass and hypovolemia.

He was subsequently transferred to the intensive care unit and blood cultures were obtained. Cardiology was consulted, and another TEE was performed due to a possible atrial mass seen on the intra operative TEE. The second TEE demonstrated a small echodensity visualized at the superior vena cava-right atrial junction, which was suggestive of a vegetation.

Due to these findings, the infectious disease service recommended to start vancomycin and cefepime. Two sets of blood cultures were obtained and one set grew Staphylococcus epidermidis. Since the only growth was Staphylococcus epidermidis the antibiotic regimen was narrowed to vancomycin.

The patient was eventually discharged with orders for vancomycin to be given at dialysis for 4 more weeks, and since repeat cultures continued to show no growth a repeat echocardiogram was not completed.

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