Abstract
A 77-year-old male diabetic patient with a two-year history of hemodialysis was admitted to Tokai University Hospital on 23 June, 2001 because of high fever and arteriovenous fistula demonstrating a reddish swelling on the left forearm. He was treated with cefazolin (CEZ) immediately after blood culture because vascular access-associated bacteremia was strongly suspected. From day 4 after admission, he had pain in his left shoulder and neck. Although the forarm infection had improved by day 5, C-reactive protein (CRP) continued to increase, reaching 23.2mg/dL. Antibiotics were changed from CEZ to Vancomycin (VCM) because Methicillin Resistant Staphylococcus aureus (MRSA) was detected on blood culture. However, left shoulder and neck pain were aggravated and persistent elevation of CRP was observed. Arbekacin (ABK) and gentamicin (GM) were administored in addition to VCM from day 9. Computed tomography (CT) scan on day 21 demonstrated a low density mass in the retropharyngeal space in front of the 3rd to 7th cervical vertebrae. From day 22, his CRP levels gradually decreased and returned to normal on day 52. The CT scan taken on the same day demonstrated complete resolution of the abscess. Because of the increased population of diabetic and elderly patients with end-stage renal disease in Japan, appropriate prevention and treatment of infections are very important for patients undergoing maintenance hemodialysis.
