[Abscess of the atrium: a complication of central venous catheters]

A 27-year-old female patient was admitted for parenteral feeding and treatment of an acute episode of her steroid dependent Crohn's disease. An intravenous catheter was inserted, the tip being located in the right atrium. This central line was accidentally removed ten days later and replaced with another one also ending in the right atrium. The patient's condition improved over a four-week period. Thereafter, she suddenly became confused and complained of abdominal pain with contracture. She displayed renal failure, coagulation disorders, and decreased blood cell counts. This was followed by a septic shock requiring mechanical ventilation and adrenaline. Laparotomy failed to reveal a cause for the patient's condition. She improved and was extubated four days later. From then on, she had fever (39 degrees C) again. Her catheter was replaced, the tip of this third one being inside the superior vena cava. Staphylococcus epidermidis was obtained from the catheter tip, as well as from four consecutive blood cultures. Despite administration of three different antibiotics, the high fever persisted (40 degrees C). Finally, the occurrence of a systolic murmur led to the discovery, with cardiac ultrasonography, of a mobile right atrial abscess, which engaged into the tricuspid valve at every contraction. Surgery to remove this mass was rapidly carried out. The bacterium was the same as that which had been isolated from the catheter. The patient improved and was able to return home a fortnight later. The diagnosis and prevention of this complication is discussed. The tip of central venous catheter should not be kept inside the atrium.