A Rare Case of Aeromonas Hydrophila Catheter Related Sepsis in a Patient with Chronic Kidney Disease Receiving Steroids and Dialysis: A Case Report and Review of Aeromonas Infections in Chronic Kidney Disease Patients
Aeromonas hydrophila (AH) is an aquatic bacterium. We present a case of fifty-five-year-old gentleman with chronic kidney disease (CKD) due to crescentic IgA nephropathy who presented to us with fever. He was recently pulsed with methyl prednisolone followed by oral prednisolone and discharged on maintenance dialysis through a double lumen dialysis catheter. Blood culture from peripheral vein and double lumen dialysis catheter grew AH. We speculate low immunity due to steroids and uremia along with touch contamination of dialysis catheter by the patient or dialysis nurse could have led to this rare infection. Dialysis catheter related infection by AH is rare. We present our case here and take the opportunity to give a brief review of AH infections in CKD patients. 1. Introduction AH is Gram-negative, rod-shaped facultative anaerobe. It can exist in aquatic environment, fish, food, birds, pets, and natural soil. AH can cause gastrointestinal and Nongastrointestinal infections. Nongastrointestinal infections include hemolytic syndrome and kidney disease, cellulitis, wound and soft-tissue infection, meningitis, bacteremia and septicemia, ocular infections, pneumonia and respiratory tract infections, and urinary tract infection in neonates, osteomyelitis, peritonitis, and acute cholecystitis [1–4]. AH can cause infection in immunocompromised host. Ko and his colleagues found AH sepsis in liver cirrhosis (54%) and malignancy (21%) [5]. AH sepsis has also been documented in other conditions which impair host immune defenses. These conditions include leukemias, lymphomas, myelodysplasia [6] diabetes mellitus, kidney dysfunction, cardiac anomalies, aplastic anemia, thalassemia, multiple myeloma, and waldenstrom macroglobulinemia [7–11]. 2. Case Report A fifty-five-year-old Afghanistan gentleman with a history of hyperthyroidism (5 years) and ischemic cardiomyopathy (2 years) presented to Aga Khan University Hospital in July 2012. He was found to have kidney failure 2 months previously and was initiated on hemodialysis due to uremic encephalopathy. He was admitted to our institution for further work-up investigations for his kidney failure. His laboratory investigations were as follows:？？hemoglobin: 9？g/dL,？？white cell counts: 4,700？u/L,？？platelet count: 171,000/mm3.Urine DR showed yellow color with clear appearance, pH of 5, specific gravity of 1.010, 4 red blood cells per high-power field, 1 WBCs per high-power field, urine protein of 1.0？g/L, and 2 RBCs cast and？urine protein to creatinine ratio: 3.9, ？？BUN: 109？mg/dL,？？creatinine: 4.8？mg/dL,？？electrolytes:
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