Fever in ESRD ; Does it Worth a Second Look ?

End Stage Renal Disease (ESRD) patients are liable for infections due to both their low immunity in comparison to general population and specific causes (i.e. recurrent central venous access needed for dialysis). So, it is logic to think about infection if a hemodialysis patient is presenting with fever. Here, we present five cases presented with fever and in spite of that, all their septic screens were negative, finally all of them turned out to have hematoma of different sizes and locations. Fever was persistent in spite of broad spectrum antibiotics given and resolved only after resolution of the hematoma. CASE 1: A Sixty Seven years old Saudi male known to have End Stage Renal Disease (ESRD) secondaryto Diabetes Mellitus (DM) and Hypertension on regular hemodialysis (HD) for few months, he had thrombosis of his Arterio-venous Fistula (AVF) and malfunctioning temporary catheter. Permanent dialysis catheter was needed to minimize the rate of infection till creation of new AVF. During insertion of the permanent catheter, suddenly the patient had severe chest pain and dyspnea. Chest x-ray (figure 1) and CT (figure 2) were done and the patient was shifted to ICU, chest tube was inserted and pure blood was drained.