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JAMA Surgery Clinical Challenge
August 2014

Unpredictable Location of Central Catheter

Author Affiliations
  • 1Department of Surgery, The Johns Hopkins University, Baltimore, Maryland
  • 2Division of Pulmonary and Critical Care Medicine, The Johns Hopkins University, Baltimore, Maryland
JAMA Surg. 2014;149(8):871-872. doi:10.1001/jamasurg.2013.3779

A man in his mid-50s presented to the hospital with malaise, fevers, hypotension, and altered mental status. Three months prior, he had an episode of native aortic valve endocarditis, necessitating aortic valve replacement with a pericardial bioprosthesis. He developed postoperative acute renal failure, which progressed to chronic renal failure requiring dialysis via tunneled catheter. On this admission, he was found to have methicillin-resistant Staphylococcus aureus (MRSA) bacteremia. Transesophageal echocardiography demonstrated a vegetation on his prosthetic aortic valve. He was diagnosed as having MRSA prosthetic valve endocarditis and admitted to the cardiovascular surgical intensive care unit prior to surgical intervention.