Extensive Superior Vena Cava Septic Thrombosis Managed by Catheter Removal with Anticoagulation and Antibiotics

Introduction: Septic thrombosis of the superior vena cava is a rare complication, difficult to recognize, and diagnosed. Superior vena cava (SVC) septic thrombosis, a serious condition requiring prompt recognition and treatment to prevent fatal complications. It develops in the SVC from central venous catheter-related bloodstream infection. Diagnosis needs high suspicion, clinical evaluation, imaging and positive blood cultures. Anticoagulation and thrombolysis maybe considered with caution due to risks of septic embolization. Thrombectomy is for those who cannot be anticoagulated. Endovascular interventions are used to recanalize the SVC and surgical bypass when all interventions failed. Addressing the underlying cause, treat the infection and anticoagulation proved to be life-saving. Case Description: An elderly diabetic, hypertensive woman, was admitted with fever, chills and hypoxemia. She is on hemodialysis via a tunneled central venous catheter via right internal jugular vein. Sepsis due to catheter-related blood stream infection was considered and given Vancomycin and Piperacillin-Tazobactam. Prompt catheter removal done. Dialysis was continued via right femoral vein. Blood culture showed Staphylococcus Epidermidis. A week after admission she had right upper thigh swelling, shortness of breath and desaturation. Chest CT scan with contrast showed extensive thrombus (8.6x1.7x1.4cm) with air attenuating foci in the SVC and right atrium. Surgical intervention was offered but the patient and family declined. A conservative approach with low molecular weight heparin and intravenous antibiotics were given. She was discharged improved on the third week of hospitalization.Outpatient dialysis via femoral access continued, with resolution of thigh swelling. Discussion: Extensive SVC septic thrombosis is a serious catheter-related complication needing urgent diagnosis and treatment. High-risk, non-intervention candidates can be managed with early catheter removal, antibiotics and anticoagulation.