A 51-year-old man with ileocolic Crohn's disease of long evolution, with multiple complications due to flares, who required intestinal resection surgery and was left with a terminal ileostomy in 2009. This year NPD was started using a fully implanted intravascular device. He was being treated with Infliximab and corticosteroids.
The following year he was admitted on several occasions for febrile syndrome associated with abdominal pain, without an obvious source and the disease itself was considered to be the origin. During these hospitalisations, Staphylococcus epidermidis was isolated in several blood cultures. The catheter was also replaced due to breakage, removing only the reservoir and the proximal portion of the catheter as the distal portion was fixed to the tissue, so that a fragment remained lodged inside the superior vena cava.
In February 2011, she presented with a similar condition with fever for 11 days and abdominal pain that progressed to septic shock and she was admitted to the ICU.
A chest X-ray showed that the abandoned fragment of the catheter was located from the superior vena cava to the right ventricle. The study was completed with an echocardiogram which showed vegetations over the catheter protruding from the atrium into the ventricle. With the diagnosis of catheter endocarditis, antibiotic treatment with Daptomycin and Rifampicin was started, taking into account previous isolations of Staphylococcus epidermidis, and cardiac surgery was performed to remove both catheters.

Initially the patient developed multi-organ dysfunction with no control of the septic picture despite antibiotic treatment. A cranial and thoraco-abdominal CT scan was performed to look for other foci of infection with the following findings: subarachnoid haemorrhage, patchy condensations in the right lung and several splenic infarctions, all compatible with multiple septic emboli.
Several isolates were found in the surgical specimen: Staphylococcus epidermidis in the functioning catheter and polymicrobial growth in the catheter with vegetation. In this case, Staphylococcus epidermidis, Ochrobactrum anthropi and a fungus identified at the National Microbiology Centre in Majadahonda as Trichorderma longibrachiatum were isolated. With these results, the antibiotic treatment was modified to Linezolid, Imipenem and Caspofungin, and the septic picture was finally controlled.
The patient had a torpid evolution with the need for prolonged mechanical ventilation and tracheostomy, pneumonia associated with mechanical ventilation due to Acinetobacter baumannii and polyneuropathy of the critical patient. After an ICU stay of 45 days, all these processes were resolved and he was transferred to the ward where he completed his recovery.