JSUR Journal

A 72-year-old male presented to the hospital with dyspnea, cough, and chest pain. He had a history of granulomatous polyangiitis leading to end-stage renal disease. He had an Arterio-Venous (AV) graft in the right arm, with an intra-graft stent placed in the past. He was afebrile initially, with a blood pressure of 138/70 mmHg, a heart rate of 98/min, and quickly required a high-flow nasal canula at 50L/min. He was found with right sided pneumonia and was treated accordingly. He later spiked a fever (38.2 °C) on day 5. Blood cultures drawn at that time grew Escherichia coli which Expressed Extended Spectrum Beta Lactamase (ESBL), antibiotics were changed to meropenem intravenously. His exam was remarkable for cardiac systolic murmur and right arm bruising on the AV graft site without tenderness (Figure 1). Echocardiogram had no vegetation. Doppler ultrasound of the AV graft showed a 1.3x2.1 cm pseudoaneurysm with thrombosis in addition to a thinappearing tubular structure suggestive of retained tubing (Figure 2). he was readmitted for pneumonia and blood cultures were negative.