![]() ![]() Numerous ill-defined serpiginous structures were identified not only in the granulomatous areas but also in the microabscess and within several arterial lumens ( Image 3) Image 4. A Kinyoun stain for acid-fast bacilli and a Gomori-methenamine silver stain for fungi were negative. Microscopy revealed patchy angiocentric granulomas with multinucleated giant cells Image 2 and Image 3 and microabscesses containing numerous neutrophils and scattered eosinophils. Bacterial and mycobacterial cultures were negative fungal culture grew Penicillium species, which was considered a contaminant. Grossly, both specimens contained multiple cavitary nodules, up to 0.8 cm in diameter, with central purulent material. Pathologic FindingsĮach wedge biopsy measured 5 cm in maximal dimension. A follow-up CT scan 8 weeks later showed marked diminution in the cavitary pulmonary nodules. ![]() Wedge biopsies of the right upper and middle lobes were performed. Immunofluorescence for respiratory viruses and cytomegalovirus was negative. Bronchoalveolar lavage culture was negative for bacteria, fungi, and acid-fast bacilli. ![]() Transbronchial biopsy was performed, and microscopy showed no diagnostic abnormality. At this level, 3 pulmonary nodules are seen in the right lung, with central cavitation in the lowermost nodule. An HIV test was negative.Ĭhest computed tomography scan with intravenous contrast. The patient quit smoking 8 months previously, and there was a remote history of cocaine and marijuana use (none within the last year). C-reactive protein was elevated, at 101.4 mg/L (965.7 nmol/L reference range, 0.0–4.9 mg/L ). Hepatitis A, B, and C serologic test results were negative. Serologic studies showed a positive p-antineutrophil cytoplasmic antibody (ANCA) c-ANCA and antimyeloperoxidase antibody were negative. The central venous catheter was removed, and a peripherally inserted central catheter was placed. Transesophageal echocardiography now showed a thrombus in the superior vena cava that was associated with the central venous catheter there were no valvular vegetations. It was a Cook Spectrum Glide, 7.0 French, triple-lumen central venous catheter impregnated with minocycline and rifampin and having a hydrophilic polymer (EZ-Pass) coating on the distal 10 cm (Cook, Bloomington, IN). Twelve days earlier, a triple-lumen central venous catheter had been inserted without difficulty or apparent complication. Blood cultures grew coagulase-negative Staphylococcus. A follow-up chest CT scan showed multiple scattered pulmonary nodules with cavitations that were suggestive of septic emboli Image 1. In addition, nodules in both lung bases were noted. Low-grade fevers developed, and computed tomography (CT) scans of the abdomen and pelvis were performed, which revealed thickening of the sigmoid and rectum. Therapy with mesalamine (Asacol), ciprofloxacin, and metronidazole was initiated. Rectal biopsies showed active chronic inflammation without granulomata, and the findings were clinically consistent with Crohn disease. Endoscopy revealed the presence of a perianal abscess and fistula tracts. The patient was a 34-year-old African American woman with a history of schizophrenia who was evaluated at an outside hospital for hematochezia and rectal pain and who subsequently underwent hemorrhoidectomy. To our knowledge, this is the first report of such a complication of hydrophilic-coated devices. We report a case of embolization of a hydrophilic polymer coating from a central venous catheter that manifested clinically with multiple cavitary lung lesions and mimicked granulomatous vasculitis. 2–4 In addition, embolization of hydrophilic polymer material from coils deployed in a cerebral artery aneurysm has recently been documented. In this regard, intense foreign body inflammatory reactions at the site of radial artery introducer sheaths for coronary angiographic procedures have been described. 1 Moreover, hydrophilic coatings have been used on central venous catheters. Interventional cardiologists and radiologists are increasingly using vascular introducer sheaths with hydrophilic coatings to facilitate ease of manipulation and minimize complications. Iatrogenic interventional devices may be associated with complications that can mimic familiar diseases. ![]()
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