A Case of a Septic Pulmonary Embolism Caused by Infection of a Subcutaneously Implanted Central Venous Port

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  • 化学療法施行中に皮下埋込型中心静脈ポート感染が原因となった敗血症性肺塞栓症の１例

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Abstract

Herein, we report the case of a patient who developed septic pulmonary embolism complicating infection of a subcutaneously implanted central venous port (CV port) during chemotherapy for breast cancer. A 53-year-old female who was diagnosed as having left breast cancer with axillary and cervical lymph node metastases, bone metastases, multiple lung metastases, and left pleural effusion was started on chemotherapy with paclitaxel and bevacizumab. A CV port was implanted for access to the right subclavian vein before administration of the second cycle of chemotherapy, because of the difficulty in establishing peripheral vascular access. Chemotherapy was then administered through the CV port. The chemotherapy was highly effective. However, the patient developed a persistent fever during the fourth cycle and was hospitalized; chest computed tomography (CT) showed multiple cavitary lesions in both lungs. Septic pulmonary embolism caused by CV port infection was suspected, the CV port was immediately removed, and antibiotic therapy started. The fever subsided immediately, and the patient was discharged on day 8. Approximately one month later, a repeat chest CT revealed complete disappearance of the pulmonary cavitary lesions. The results of both two sets of blood culture and catheter tip culture obtained later revealed growth of Methicillin-Sensitive Staphylococcus Aureus (MSSA). Complications after CV port implantation include infection, which can sometimes lead to serious complications such as septic pulmonary embolism. In cases of suspected CV port infection, the CV port should be immediately removed and antibiotic therapy initiated promptly. In addition, it is also important to consider septic pulmonary embolism complicating port infection in the differential diagnosis in cases presenting with pulmonary nodular or cavitary lesions.

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