# Septic Emboli to the Brain Secondary to a Patent Foramen Ovale: A Rare Complication of Internal Jugular Vein Catheter

## TL;DR

A rare case of brain septic emboli in a hemodialysis patient is linked to a patent foramen ovale, allowing infection spread from a vein catheter.

## Contribution

This case report highlights a novel association between a patent foramen ovale and septic emboli to the brain from a hemodialysis catheter.

## Key findings

- A 30-year-old male with a patent foramen ovale developed septic emboli to the brain from an infected hemodialysis catheter.
- The presence of a patent foramen ovale is suspected to have facilitated right-to-left shunting of septic emboli.
- Septic emboli to the brain from a catheter site, rather than valvular vegetation, is a rare and previously unreported complication.

## Abstract

The prolonged use of hemodialysis catheters is associated with several complications with infection being the most common. The increased susceptibility to infections in patients on hemodialysis can be attributed to decreased immunity, though age, other comorbidities, and properties of the catheter act as modifiers. Hematogenous spread of the infection can lead to sepsis and seeding into other organs. In this article, we report an unusual case of septic emboli to the brain in a 30-year-old male on prolonged use of a right internal jugular vein (IJV) catheter for hemodialysis. An interesting finding in the case was the presence of a patent foramen ovale (PFO), a persisting embryonic structure that allows right-to-left shunting. It is suspected that this PFO led to the passage of septic emboli from the right IJV site to the brain. Before our case, septic emboli to the brain have been reported to occur from valvular vegetation in case of infective endocarditis. The mainstay of managing patients with septic emboli is the use of antibiotics; additional interventions may be needed on a case-to-case basis.