Catheter-Related Septic Subclavian Thrombophlebitis Presenting as a Rapidly Progressive Cervical Abscess in a Hemodialysis Patient: A Fatal Case Report

Central venous catheters remain widely used for hemodialysis access, particularly in patients who lack suitable permanent vascular access. Although catheter-related infections are well recognized, severe deep neck infections secondary to catheter-associated septic thrombophlebitis are rarely reported. We report the case of a 75-year-old man with end-stage kidney disease on long-term hemodialysis who presented with a rapidly enlarging painful right cervical swelling. His medical history included multiple failed arteriovenous fistulas and repeated central venous catheterizations for dialysis access. Physical examination revealed a firm erythematous cervical mass without airway compromise. Laboratory investigations demonstrated marked leukocytosis and elevated inflammatory markers. Contrast-enhanced computed tomography of the neck showed a large cervical collection with internal gas and rim enhancement consistent with a deep abscess. Imaging also demonstrated thrombosis of the right subclavian vein raising suspicion for septic thrombophlebitis, along with extensive surrounding inflammatory changes and gas tracking toward adjacent osseous structures mainly the sternoclavicular joint, raising suspicion for emphysematous osteomyelitis. The patient was started on broad-spectrum intravenous antibiotics and underwent urgent surgical drainage of the abscess. Anticoagulation therapy was initiated for the associated septic venous thrombosis. Despite aggressive medical and surgical management, the patient’s condition deteriorated rapidly and he died several days later due to overwhelming infection. Presumed catheter-related septic thrombophlebitis can lead to devastating complications including deep cervical infection and possible emphysematous osteomyelitis. This case highlights the importance of early recognition of unusual infectious complications of long-term dialysis catheters and underscores the need for vigilance in patients with repeated vascular access interventions.