Abstract
A 52-year-old woman who presented with severe burns developed arterial thrombi because of the insertion of a monitoring catheter. We took a conservative management approach, but the patient soon developed bacteremia and her condition worsened. She subsequently died of sepsis including septic pulmonary emboli, the foci of which were strongly suspected to be the arterial thrombi. If a monitoring catheter is mandatory in compromised patients, it should be inserted with extreme caution and care. Moreover early removal of arterial thrombi that develop in such patients is needed, because these thrombi could become infectious foci of persistent bacteremia.