A case of pneumothorax secondary to septic pulmonary embolism due to central venous catheter infection caused by methicillin-resistant Staphylococcus aureus

Abstract

A 72-year-old woman with deteriorated renal function underwent hemodialysis with a central venous double lumen catheter and was treated with predonisolone when diagnosed with MPO-ANCA associated rapidly progressive glomerulonephritis. She developed a high fever. On hospital day 64, the central venous catheter was removed immediately, and VCM and RFP were started. On hospital day 70, chest CT showed multiple nodular cavitated lesions, and she was diagnosed as septic pulmonary embolism (SPE). Six days later, chest radiography showed asymptomatic right hydropneumothorax. An intercostal tube was inserted and purulent fluid drained. Methicillin-resistant Staphylococcus aureus was isolated from blood culture, the central venous catheter, and pleural effusion. Her condition improved slowly, and she was discharged mobile on hospital day 129. Pneumothorax is reported to be a rare but possibly lethal complication of SPE in intravenous drug abusers. To our knowledge, this is the first case report of pneumothorax secondary to SPE due to central venous catheter infection. SPE related to intravascular devices or catheters has been increasing, and the significance of this SPE complication in the critically ill should be recognized.