Inverse paradoxical embolism in a patient on chronic hemodialysis with aortic bacterial endocarditis

We present a 45-year-old patient on chronic hemodialysis who suffered aorti c endocarditis by Staphylococcus haemolyticus after bacteremia associated w ith a venous catheter, which was used temporarily during the maturing phase of a Cimino-Brescia arteriovenous fistula in the left forearm. Three weeks after starting antibiotic therapy, the patient suffered a septic pulmonary embolism. The catheter had been removed 4 weeks before the embolism. Throm bophlebitis of lower limbs, infection or thrombosis of the vascular access, and the involvement of right-sided cardiac structures were all discarded. We assumed that the pulmonary episode was probably a consequence of the par adoxical passage of embolic material, detached from the aortic valve, from arterial to venous circulation through the arteriovenous fistula. (C) 1999 by the National Kidney Foundation, Inc.