Infected Hemodialysis Arteriovenous Fistula with Distant Explosive Pleuritis: A Rare Phenomenon

Patient: Male, 36-year-old Final Diagnosis: Explosive pleuritis Symptoms: Abdominal pain Medication:— Clinical Procedure: — Specialty: Critical Care Medicine • Infectious Diseases • General and Internal Medicine • Nephrology • Pulmonology OBJECTIVE: Unusual clinical course BACKGROUND: The management of patients with end-stage kidney disease can be accomplished with hemodialysis via a surgically created arteriovenous fistula. An arteriovenous fistula has an advantage because of the ability to serve as permanent access for hemodialysis over several months to years; however, it has a disadvantage because of its associated vascular and infectious complications. An infectious complication such as explosive pleuritis, which is usually due to respiratory infections, in the setting of an infected arteriovenous fistula site infection, is extremely rare. CASE REPORT: A 36-year-old man with a past medical history of IgA nephropathy on hemodialysis with a left forearm arteriovenous fistula presented to the Emergency Department because of left flank pain. Despite no recent history or evidence of a respiratory tract infection, he developed explosive pleuritis within 48 h. The presence of Group A Streptococcus at the arteriovenous fistula site coincided with Streptococcus pyogenes infection. The pleural ef-fusion was drained and he was treated with antibiotics. He recovered and was eventually discharged home. CONCLUSIONS: Explosive pleuritis, although less frequent, is almost always secondary to respiratory tract infections. An arteriovenous fistula site infection may be the source of infection of an internal organ if no apparent source is identified.