SHM Converge Scientific Abstract ePoster Gallery-A Case of Infective Endocarditis on a Central-Catheter Associated Sheath

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This case describes a 45-year-old woman with agammaglobulinemia and severe gastroparesis who required long-term total parenteral nutrition through a Hickman catheter. Two years after catheter placement, she presented with confusion, weakness, abdominal pain, and septic shock. Blood cultures grew MRSA and Candida albicans, and she was started on vancomycin and caspofungin. After catheter removal, TTE showed no vegetations, but persistent bacteremia prompted TEE, which revealed a fibrin sheath at the superior vena cava–right atrium junction with a mobile vegetation. CT imaging also showed bilateral pleural effusions and septic pulmonary emboli.<br /><br />Because of her poor nutritional status and the small size of the sheath, the team chose medical management over thrombectomy or stripping. She received prolonged IV vancomycin and antifungal therapy, which was adjusted multiple times due to QT prolongation and later concern for ocular and CNS involvement, ultimately requiring amphotericin B for better penetration. She also received anticoagulation with unfractionated heparin, later bridged to warfarin.<br /><br />Follow-up TEE showed persistent fibrin sheath despite treatment, though the adherent vegetation eventually resolved. After initial sterilization of blood cultures, she developed recurrent fever and new MSSA bacteremia, demonstrating the ongoing risk of infected fibrin sheaths. The discussion emphasizes that these lesions are often only detected by TEE, can cause persistent bacteremia, and currently have no formal management guidelines. Treatment generally includes prolonged antimicrobials plus anticoagulation and/or thrombectomy. Early recognition and prevention through careful catheter use and timely removal remain key.

Asset Subtitle

Eric M. Mortensen

Meta Tag

Author List Anthony Dotur, Bahga Katamesh, Dana Potashner, Eric M. Mortensen, Samuel Antonio Padilla Abreu

Category Clinical Vignettes

Concept Infected Fibrin Sheath Endocarditis

Concept Fibrin Sheath Vegetation

Concept Intravascular Device

Concept Bacteremia

Concept Transesophageal Echocardiography

Distinguished Non-Finalist

Presenter Organization UConn Health

Presenting Author Eric M. Mortensen

Track Adult

Keywords

agammaglobulinemia

septic shock

Hickman catheter

total parenteral nutrition

MRSA bacteremia

Candida albicans

transesophageal echocardiography

fibrin sheath

septic pulmonary emboli

anticoagulation

Infected Fibrin Sheath Endocarditis

Fibrin Sheath Vegetation

Intravascular Device

Bacteremia

Transesophageal Echocardiography