BMJ Case Reports 2017; doi:10.1136/bcr-2016-219060

Fibrin sheath-associated endovascular infection of the heart: the Trojan horse of indwelling central venous catheters

  1. Shaun Cardozo2
  1. 1 Internal Medicine, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
  2. 2 Cardiology, Wayne State University School of Medicine/Detroit Medical Center, Detroit, MI, USA
  1. Correspondence to Dr Muhammad Adil Sheikh, madilsheikh{at}
  • Accepted 23 March 2017
  • Published 17 April 2017


Chronic indwelling central venous catheters can result in formation of fibrin sheaths increasing risk of occlusion, thrombosis and infection. Endovascular infection of right-sided heart structures induced by such sheaths is very rare. A 48-year-old woman with end-stage renal disease initially treated for diabetic ketoacidosis developed persistent Staphylococcus epidermidis bacteraemia without an identifiable source. Although transthoracic echocardiography was unremarkable, transoesophageal echocardiography revealed a fibrin sheath and vegetations in superior vena cava–right atrium junction, which was the site of the tip of a central catheter that had been removed 2 months prior, consistent with fibrin sheath-associated endovascular infection. The bacteraemia cleared and clinical improvement was seen with prolonged intravenous vancomycin. In patients with unexplained bacteraemia and history of a central catheter, rare causes of endovascular infections of right-sided heart structures like fibrin sheaths should be considered. These can persist months after catheter removal. Transoesophageal echocardiogram should be used for earlier detection.


  • Contributors MAS, MS and WI were involved in the case and writing of the manuscript.

    SC was the supervising senior physician on the case and responsible for revision of the manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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