Relapsing pyrogenic reactions due to Xanthomonas maltophilia in a dialysis patient with a long-term central venous catheter

A 72-year-old male was admitted to the renal unit in November 1994 to begin dialysis treatment. He suffered from CRF due to chronic vascular disease with hypertension and generalized atherosclerosis. Due to the high risk of failure associated with a-v fistulas, we preferred to insert percutaneously a longterm central duoble-lumen venous catheter in the right subclavian vein, through a short subcutaneous tunnel. Dialysis was performed according to a standard schedule (3.30 h x 3) using a virtually sterile modified acetate membrane filter and a bicarbonate powder cartridge system. During the first 3 months of treatment, the patient did not experience any problems during or after the dialysis session. Suddenly, during the second hour of a dialysis session, he had a first episode of ingravescent chills typically observed in a pyrogenic reaction. The bicarbonate system was replaced and an i.v. hydrocorticosteroid bolus was administered. The patient did not respond satisfactorily to treatment and the symptoms did not disappear until after the end of the dialysis session. The patient always had the same