Infective tricuspid valve endocarditis with septic pulmonary emboli due to puncture of an endogenous arteriovenous fistula in a chronic hemodialysis patient.

Background: Patients on chronic hemodialysis are at high risk for infectious endocarditis due to prosthetic access devices such as cuffed venous catheters and polytetrafluoroethylene grafts. Right-sided endocarditis without any predisposing factors is rare in dialysed patients.

Case Report: A 42-year-old man with chronic renal failure was referred to hospital due to febrile temperatures. Hemodialysis was performed via an autogenous arteriovenous fistula. He had neither any recognized underlying valve disease nor any percutaneous interventions previously. Chest radiography and computed-tomography revealed numerous lung abscesses caused by tricuspid endocarditis detected by transesophageal echocardiography. Antibiotics were given for 5 weeks curing the infection without necessity of surgical treatment.

Conclusions: Primary arteriovenous fistulas have the lowest rates of infections and are the access of choice for chronic hemodialysis patients. However, repeated vascular punctures even of autogenous grafts expose dialysis patients to bacteremia and imply a higher risk of infectious endocarditis.