Endophthalmitis, a rare metastatic bacterial complication of haemodialysis catheter-related sepsis

It is well-recognized that the arterio-venous (A/V) fistula is the best form of access to the circulation for maintenance haemodialysis [1]. The A/V fistula is less likely to fail than other methods of access, such as the Polytetrafluoroethylene graft, the tunnelled dialysis catheter and the emergency temporary dialysis catheter. Furthermore, a good A/V fistula reduces the risk of bacteraemia and the morbidity, mortality and hospitalization associated with that complication. Even when an A/V fistula has been in long-term use, it is possible for the access to be lost suddenly through thrombosis or localized infection. Under these circumstances, emergency temporary vascular access is required, using percutaneous polyurethane catheters inserted directly into the jugular or femoral veins. The risk of bacterial infection with these lines is high, ranging from localized infection at the exit site to bacteraemic illness with systemic symptoms and on to life-threatening conditions such as endocarditis, metastatic pyaemia and paravertebral abscess. We report an unusual case of metastatic infection in the form of acute endophthalmitis, and make some observations on clinical management of this rare condition.