[Case report : Rare case of a spontaneous pseudoaneurysm of the superficial femoral artery revealing Behçet's disease in a young patient]. / Cas clinique : cas rare d'un faux anévrisme spontané de l'artère fémorale superficielle révélant une maladie de Behçet chez un jeune patient.

Behçet's disease is a chronic inflammatory vascular disorder that can affect arteries and veins of various sizes. Arterial involvement, which plays a significant prognostic role, requires a treatment approach involving corticosteroids, immunosuppressants, and potentially surgical or endovascular procedures. This article presents the case of a young man diagnosed with Behçet's disease, manifested by a spontaneous pseudoaneurysm in the superficial femoral artery. The patient underwent surgical intervention to remove the pseudoaneurysm and restore circulation using a venous graft. This case underscores the importance of considering Behçet's disease in vascular manifestations.

Severe tricuspid valve endocarditis related to tunneled catheters in chronic hemodialysis patients: when should the catheter be removed?

INTRODUCTION: Hemodialysis (HD) patients are predisposed to infective endocarditis (IE) mainly due to repeated manipulation of the vascular access. However, catheter seeding and IE may also result from a distant infection site. CASE SERIES: A diabetic patient who was maintained on regular HD through a permanent catheter in the right internal jugular vein presented with septicemia of urinary origin due to Pseudomonas aeruginosa. He was treated with injectable antibiotics for 15 days. Few days after the end of the treatment period he presented with inflammation of the catheter exit site. Blood cultures revealed Pseudomonas aeruginosa and echocardiography showed a large vegetation on the tricuspid valve, confirming the diagnosis of IE. The patient improved after catheter removal and treatment with ceftazidime, vancomycin and amikacin. Another patient who was maintained on chronic HD through a tunneled catheter in the right internal jugular vein presented with a limited infection in the sub-cutaneous tunnel of the catheter that improved after treatment with injectable antibiotics. Two months later, he presented with severe sepsis without signs of local infection of the catheter. Chest radiography showed right sided infiltrates. Injectable antibiotic therapy was given without improvement. Blood cultures were negative but echocardiography showed a large tricuspid valve vegetation. Antibiotic regimen was modified to include vancomycin, amikacin and ceftazidime and the catheter was removed. Unfortunately, the patient died two days after diagnosing IE. CONCLUSION: catheter seeding and IE may be a consequence of sepsis originating away from the HD catheter site. Tunneled catheters may need to be preemptively removed in such situations to prevent serious IE.