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Anuradha Chakravarthy, MD; William D. Edwards, MD; C. Richard Fleming, MD

JAMA. 1987;257(6):801-803.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

LONG-TERM home parenteral nutrition (HPN) has been associated with septic, mechanical, and metabolic complications.^1,2 We recently observed a catheter-related complication that has not, to our knowledge, been reported in an adult. A large infected thrombus was attached to the tip of a Hickman catheter and obstructed the tricuspid orifice; it was probably the source of the patient's fever of undetermined origin, metastatic soft-tissue infections, and death.

Report of a Case

A 56-year-old woman with a history of arthritic symptoms was diagnosed to have progressive systemic sclerosis on the basis of Raynaud's phenomenon, sclerodactyly, finger ulcers, dysphagia, telangiectasis, antinuclear antibody (positive at a 1:4096 titer, nucleolar pattern), and rheumatoid factor (reactive at a 1:640 titer). During the next two years, her symptoms worsened. She was hospitalized three times in two months for recurrent bouts of intestinal pseudo-obstruction.

A Hickman catheter was placed for HPN after efforts at enteral nutrition failed. . . . [Full Text PDF of this Article]

Author Affiliations
From the Departments of Internal Medicine (Division of Gastroenterology) (Drs Chakravarthy and Fleming) and Pathology (Dr Edwards), Mayo Clinic, Rochester, Minn.

Footnotes
Reprint requests to Mayo Clinic, Rochester, MN 55905 (Dr Fleming).

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