Khan Behram, Strate Randall W, Hellman Richard
Department of Internal Medicine (Division of Nephrology), Indiana University Medical School, Indianapolis, Indiana, USA.
Semin Dial. 2007 Sep-Oct;20(5):452-4. doi: 10.1111/j.1525-139X.2007.00247.x.
Myocardial abscess formation is a life-threatening complication that is frequently but not exclusively associated with infective endocarditis. To our knowledge there are only two case reports of myocardial abscess formation in hemodialysis patients. Only one of these reports describes a myocardial abscess of bacterial etiology secondary to an infected intravascular hemodialysis catheter. Furthermore, there are no reports of bacterial myocardial abscess occurring in a hemodialysis patient with an infected arteriovenous fistula. Myocardial abscess can manifest in a variety of clinical scenarios ranging from an asymptomatic state to a catastrophic myocardial wall rupture. In the case described, the myocardial abscess lead to a rapidly progressive course consisting of recurrent cardiac arrhythmias that were ultimately fatal. Our case involved the formation of a myocardial abscess in the presence of a methicillin-resistant Staphylococcus aureus bacteremia without any evidence of infective endocarditis. We report this case to call attention to the possibility of bacterial myocardial abscess occurring with infection of an arteriovenous fistula in a hemodialysis patient, which can manifest as recurrent severe cardiac arrhythmias refractory to medical therapy.
心肌脓肿形成是一种危及生命的并发症，常与感染性心内膜炎相关，但并非仅见于此。据我们所知，血液透析患者发生心肌脓肿形成的病例报告仅有两例。其中仅有一篇报告描述了继发于感染性血管内血液透析导管的细菌性心肌脓肿。此外，尚无关于感染动静脉内瘘的血液透析患者发生细菌性心肌脓肿的报告。心肌脓肿可在多种临床情况下出现，从无症状状态到灾难性的心肌壁破裂。在所描述的病例中，心肌脓肿导致了快速进展的病程，包括反复发作的心律失常，最终导致死亡。我们的病例是在耐甲氧西林金黄色葡萄球菌菌血症存在的情况下形成心肌脓肿，且无任何感染性心内膜炎的证据。我们报告此病例是为了引起对血液透析患者动静脉内瘘感染时发生细菌性心肌脓肿可能性的关注，其可表现为对药物治疗难治的反复发作的严重心律失常。
