CONGRESS ABSTRACT

A 52-year-old male with a history hypertension, type 2 diabetes mellitus complicated by diabetic foot, and stage V chronic kidney disease, has been undergoing thrice-weekly hemodialysis via a central venous catheter (CVC) placed in the left jugular vein since 2022. During this time, he experienced recurrent episodes of post-dialysis sepsis, with methicillin resistant Staphylococcus aureus (MRSA) identified in CVC blood cultures. In September 2022, following a CVC malfunction, transcatheter cavography revealed severe stenosis of the right brachiocephalic trunk. In 2023, a stent was placed to address the stenosis. However, this was complicated by caudal displacement of the stent into the region between the superior vena cava and the right atrium. A conservative strategy was decided. In October 2024, the patient presented with fever and new MRSA isolation, prompting treatment with IV vancomycin during dialysis sessions. A transthoracic echocardiogram showed no vegetations. In November 2024, he developed hyperpyrexia and general malaise while on vancomycin lock therapy, so hospitalization was. A Positron Emission Tomography – Computed Tomography revealed D8-D9 vertebras hypercaptation and endocarditis involving the CVC and the displaced caval stent and exclude peripheral embolization. Transesophageal echocardiography confirmed a large mass adherent to the dislodged stent in the right atrium, characterized by frayed edges and hypo-hyperechoic regions, consistent with vegetation at high risk of embolization. Given the clinical presentation characterized by the presence of highly mobile mass of significant size, the case was discussed with the cardiac surgeons and the decision was made to proceed with cardiac surgery. Thus, the patient was referred to Parma University Hospital, where he underwent cardiac surgery for the removal of the infected mass, stent, and CVC. Postoperatively, the patient was transferred to intensive care for three days and subsequently moved to the nephrology department. Right-sided infective endocarditis (IE) accounts for 5–10% of all IE cases and is often associated with intravenous drug use, intracardiac devices, and central venous catheters—devices. According to the 2023 European Society of Cardiology guidelines, surgery is recommended in cases of uncontrolled infection, as it improves 1-year survival rates by 15–20%. Moreover, surgery reduces embolic risk, particularly in cases of MRSA, which has seen a rising incidence.