All that is swollen and red is not infection!

Area of Science:

• Nephrology
• Vascular Surgery
• Transplant Surgery

Background:

• Unilateral upper extremity swelling and pain are common clinical presentations.
• Differential diagnoses include cellulitis, abscess, lymphoedema, and venous thrombosis.

Observation:

• A renal transplant recipient presented with swelling and pain in one upper limb.
• The patient's condition was diagnosed as cellulitis.
• The underlying cause was native radiocephalic arteriovenous (AV) fistula-related venous hypertension.

Findings:

• The patient's arteriovenous (AV) fistula-related venous hypertension was misdiagnosed as cellulitis.
• Surgical ligation of the AV fistula led to patient improvement.

Implications:

• This case highlights the importance of maintaining a high index of suspicion for unusual causes of upper extremity swelling.
• Careful clinical examination is crucial to avoid misdiagnosis and potentially dangerous treatments.
• Accurate diagnosis and timely intervention are essential for patient well-being in transplant recipients.