Pulmonary Septic Emboli and Pseudomonas Pneumonia: Complication of Hemodialysis Catheter

A 33 year old woman was admitted to our hospital with fever, chest pain, and vomiting. Chest pain was pleuritic and was worse with inspiration. The patient was febrile for 6 days before evaluation. Her past medical history was significant for systemic lupus erythematosus (SLE), chronic renal failure on chronic hemodialysis, and hypertension. Physical examination showed temperature of 103°F, heart rate of 125/min, respiratory rate of 28/min, and blood pressure of 142/88 mmHg. The patient was ill-appearing and mildly tachypnic. Chest exam was remarkable for bilateral basilar crackles. Heart and abdominal exam were unremarkable. Mild erythema surrounding the right anterior chest wall venous catheter site was noted. Chest imaging studies during hospitalization are shown in figure1.