This case highlights the rare occurrence of Clostridium perfringens bacteremia associated with an intracardiac thrombus and an indwelling central venous catheter in a patient with advanced heart failure.
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Suggests vigilance for C. perfringens bacteremia with catheters and right atrial masses in HF; hypothesis-generating and requires confirmation.
A 70-year-old man with ischemic dilated cardiomyopa- thy and a known right atrial mass, presumed to be thrombus, presented to the hospital with 3 weeks of fevers and chills. One year before this admission, transesophageal echocardiography had demonstrated a 33-cm mass in the right atrium, extending into the superior vena cava (Figure, panel a). The mass was contiguous with the tip of a Groshong catheter, which was used for home dobutamine infusion. Because of a high operative risk at that time, the patient had declined surgical resection of the right atrial mass. During the present hospital admission, the Groshong catheter was removed after 4 of 6 blood cultures grew Clostridium perfringens. The presumed source of the bacteremia was the patient's oropharynx, because he had
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Chowdhury et al. (1999) studied this question.
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