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A complicated case of Serratia marcescens catheter-related bloodstream infection misdiagnosed as hypersensitivity reactions to bicarbonate dialysate containing acetate

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Abstract

Recurrent fever during/post-dialysis can occur due to infectious or non-infectious causes. We present the case of a 79-year-old patient who had persistent post-dialysis fever after long-term tunneled central venous catheterization with acetate-containing bicarbonate dialysate. Drug-induced lymphocyte stimulation test (DLST) was positive for acetate dialysate, and he was suspected of having acetate dialysate-induced hypersensitivity reaction. However, switching to acetate-free dialysate did not attenuate the fever. Since Serratia marcescens had been isolated twice from the blood, catheter-related bloodstream infection (CRBSI) was suspected. The culture of the catheter tip confirmed CRBSI caused by S. marcescens. Elevation of β-d-glucan levels and appearance of pulmonary nodular shadow on chest computed tomography images indicated complicated fungal infections. Administration of antibiotics and antifungals led to resolution of the pulmonary nodular shadow with attenuation of fever and C-reactive protein levels. DLST for acetate dialysate was negative, and its reuse did not aggravate the symptoms; hence, the first result was considered false-positive. An indwelling catheter is a risk factor for S. marcescens-related CRBSI, which leads to post-dialysis fever. Hypersensitivity reactions to dialysates must be diagnosed considering the clinical course and DLST results.

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Authors and Affiliations

  1. Department of Kidney Disease, Kawashima Hospital, 1-39 Kitasakoichiban-cho, Tokushima, Tokushima, 770-0011, Japan

    Hisato Shima, Tomoko Inoue, Manabu Tashiro, Kazuhiko Kawahara, Kazuyoshi Okada & Jun Minakuchi

  2. Department of Laboratory, Kawashima Hospital, 1-39 Kitasakoichiban-cho, Tokushima, 770-0011, Japan

    Takuya Okamoto & Norimichi Takamatsu

  3. Clinical Engineering Department, Kawashima Hospital, 1-39 Kitasakoichiban-cho, Tokushima, Tokushima, 770-0011, Japan

    Yusaku Tanaka

  4. Department of Cardiovascular Surgery, Kawashima Hospital, 1-39 Kitasakoichiban-cho, Tokushima, 770-0011, Japan

    Seiichiro Wariishi

Authors
  1. Hisato Shima
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  2. Takuya Okamoto
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  3. Tomoko Inoue
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  5. Yusaku Tanaka
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  8. Kazuhiko Kawahara
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  9. Kazuyoshi Okada
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  10. Jun Minakuchi
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Correspondence to Hisato Shima.

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Shima, H., Okamoto, T., Inoue, T. et al. A complicated case of Serratia marcescens catheter-related bloodstream infection misdiagnosed as hypersensitivity reactions to bicarbonate dialysate containing acetate. CEN Case Rep 11, 55–59 (2022). https://doi.org/10.1007/s13730-021-00624-8

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  • DOI: https://doi.org/10.1007/s13730-021-00624-8

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