Case: 78 year old female is brought back from home with fever, chills, hypotension associated with right pelvic pain. Patient is diagnosed having septic shock with right hip septic arthritis, confirmed by MRI. Patient was previously discharged from hospital two weeks ago after getting treated for community acquired pneumonia. Patient CXR on present admission is improved and sputum gram stain is negative. Urine screen is negative. Review of chart shows emergent insertion of femoral line in ER on previous admission which required 'few attempts' by an intern. Central line was removed on discharge.
Answer: Femoral central line induced hip arthritis
Objective of above question is to highlight relatively unknown complications of central lines. Joint infections from central line rarely get mentioned, but they have been described in literature. Similarly, known complication of subclavian central line is sternoclavicular joint arthritis.
(see case reports in references)
1. Clin Rheumatol 1994; 13:507. Fromm SE, Toohey JS. Septic arthritis of the hip in an adult following repeated femoral venipuncture. Orthopedics 1996; 19:1047.
2. Aglas F, Gretler J, Rainer F, Krejs GJ. Sternoclavicular septic arthritis: a rare but serious complication of subclavian venous catheterization.