Fatal Tricuspid Valve Obstruction due to a Large Infected Thrombus Attached to a Hickman Catheter

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Abstract
LONG-TERM home parenteral nutrition (HPN) has been associated with septic, mechanical, and metabolic complications.1,2 We recently observed a catheter-related complication that has not, to our knowledge, been reported in an adult. A large infected thrombus was attached to the tip of a Hickman catheter and obstructed the tricuspid orifice; it was probably the source of the patient's fever of undetermined origin, metastatic soft-tissue infections, and death. Report of a Case A 56-year-old woman with a history of arthritic symptoms was diagnosed to have progressive systemic sclerosis on the basis of Raynaud's phenomenon, sclerodactyly, finger ulcers, dysphagia, telangiectasis, antinuclear antibody (positive at a 1:4096 titer, nucleolar pattern), and rheumatoid factor (reactive at a 1:640 titer). During the next two years, her symptoms worsened. She was hospitalized three times in two months for recurrent bouts of intestinal pseudo-obstruction. A Hickman catheter was placed for HPN after efforts at enteral nutrition failed.

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