The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient
Abstract Background Post-dialysis fever is a common but diagnostically challenging issue in hemodialysis patients, with potential causes including dialysis-related infections, pulmonary infections, and cardiovascular complications. Case presentation We report a 76-year-old male with end-stage renal...
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BMC
2025-07-01
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| Series: | BMC Nephrology |
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| Online Access: | https://doi.org/10.1186/s12882-025-04236-7 |
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| author | Xinyu Wang Yu Xie Meiyu Chen Hongyan Zhu Guonian He Wenjing Yu Dan Qiao Ying Shen Lu Song Qinyuan Deng |
| author_facet | Xinyu Wang Yu Xie Meiyu Chen Hongyan Zhu Guonian He Wenjing Yu Dan Qiao Ying Shen Lu Song Qinyuan Deng |
| author_sort | Xinyu Wang |
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| description | Abstract Background Post-dialysis fever is a common but diagnostically challenging issue in hemodialysis patients, with potential causes including dialysis-related infections, pulmonary infections, and cardiovascular complications. Case presentation We report a 76-year-old male with end-stage renal disease (ESRD) on maintenance hemodialysis, coronary artery disease, and prior cardiac stent implantation, who presented with recurrent post-dialysis fever. Despite persistently negative conventional cultures, metagenomic next-generation sequencing (NGS) of pre-dialysis blood samples identified Pseudomonas aeruginosa (P. aeruginosa), Cutibacterium acnes (C. acnes; formerly Propionibacterium acnes), Staphylococcus epidermidis (S. epidermidis), and Corynebacterium accolens (C. accolens) and Epstein-Barr virus (EBV), while post-dialysis samples revealed only C. acnes and EBV. Given the temporal association with fever, these two pathogens were considered the primary causative agents. Subsequent transesophageal echocardiography (TEE) confirmed aortic valve vegetations, establishing the diagnosis of infective endocarditis (IE). Following targeted antimicrobial and antiviral adjustments based on NGS findings, the patient exhibited complete resolution of post-dialysis fever and was discharged. However, as the vegetation was not surgically removed, he was hospitalized multiple times over the following five months for recurrent infections and ultimately died of septic shock and multi-organ failure due to carbapenem-resistant Klebsiella pneumoniae. Conclusions This case underscores the complementary role of TEE and NGS in diagnosing IE in high-risk patients, enabling the detection of uncommon pathogens and informing targeted therapy to improve clinical outcomes. Clinical trial number Not applicable. |
| format | Article |
| id | doaj-art-6dbec0e5025d457193e8ff47bd8b40a2 |
| institution | Kabale University |
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| language | English |
| publishDate | 2025-07-01 |
| publisher | BMC |
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| series | BMC Nephrology |
| spelling | doaj-art-6dbec0e5025d457193e8ff47bd8b40a22025-08-20T03:45:24ZengBMCBMC Nephrology1471-23692025-07-012611910.1186/s12882-025-04236-7The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patientXinyu Wang0Yu Xie1Meiyu Chen2Hongyan Zhu3Guonian He4Wenjing Yu5Dan Qiao6Ying Shen7Lu Song8Qinyuan Deng9Department of Nephrology, The First People’s Hospital of Yunnan ProvinceDepartment of Nephrology, The First People’s Hospital of Yunnan ProvinceThe Affiliated Hospital of Kunming University of Science and TechnologyThe Affiliated Hospital of Kunming University of Science and TechnologyDepartment of Infection I, The Third People’s Hospital of KunmingThe Affiliated Hospital of Kunming University of Science and TechnologyThe Affiliated Hospital of Kunming University of Science and TechnologyDepartment of Nephrology, The First People’s Hospital of Yunnan ProvinceThe Affiliated Hospital of Kunming University of Science and TechnologyDepartment of Nephrology, The First People’s Hospital of Yunnan ProvinceAbstract Background Post-dialysis fever is a common but diagnostically challenging issue in hemodialysis patients, with potential causes including dialysis-related infections, pulmonary infections, and cardiovascular complications. Case presentation We report a 76-year-old male with end-stage renal disease (ESRD) on maintenance hemodialysis, coronary artery disease, and prior cardiac stent implantation, who presented with recurrent post-dialysis fever. Despite persistently negative conventional cultures, metagenomic next-generation sequencing (NGS) of pre-dialysis blood samples identified Pseudomonas aeruginosa (P. aeruginosa), Cutibacterium acnes (C. acnes; formerly Propionibacterium acnes), Staphylococcus epidermidis (S. epidermidis), and Corynebacterium accolens (C. accolens) and Epstein-Barr virus (EBV), while post-dialysis samples revealed only C. acnes and EBV. Given the temporal association with fever, these two pathogens were considered the primary causative agents. Subsequent transesophageal echocardiography (TEE) confirmed aortic valve vegetations, establishing the diagnosis of infective endocarditis (IE). Following targeted antimicrobial and antiviral adjustments based on NGS findings, the patient exhibited complete resolution of post-dialysis fever and was discharged. However, as the vegetation was not surgically removed, he was hospitalized multiple times over the following five months for recurrent infections and ultimately died of septic shock and multi-organ failure due to carbapenem-resistant Klebsiella pneumoniae. Conclusions This case underscores the complementary role of TEE and NGS in diagnosing IE in high-risk patients, enabling the detection of uncommon pathogens and informing targeted therapy to improve clinical outcomes. Clinical trial number Not applicable.https://doi.org/10.1186/s12882-025-04236-7Post-dialysis feverInfective endocarditis (IE)Transesophageal echocardiography (TEE)Next-generation sequencing (NGS) |
| spellingShingle | Xinyu Wang Yu Xie Meiyu Chen Hongyan Zhu Guonian He Wenjing Yu Dan Qiao Ying Shen Lu Song Qinyuan Deng The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient BMC Nephrology Post-dialysis fever Infective endocarditis (IE) Transesophageal echocardiography (TEE) Next-generation sequencing (NGS) |
| title | The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient |
| title_full | The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient |
| title_fullStr | The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient |
| title_full_unstemmed | The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient |
| title_short | The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient |
| title_sort | complex diagnosis of post dialysis fever a case report and literature review of infective endocarditis in a dialysis patient |
| topic | Post-dialysis fever Infective endocarditis (IE) Transesophageal echocardiography (TEE) Next-generation sequencing (NGS) |
| url | https://doi.org/10.1186/s12882-025-04236-7 |
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