Sepsis and a painful shoulder in a haemodialysis patient

Soft tissue infections are common in patients with endstage renal failure, particularly those with concomitant diabetes and peripheral vascular disease. They usually affect the lower extremities and their microbiology is dominated by gram-positive organisms. Empirical antibiotic treatment is usually straightforward, and success or failure is heavily influenced by the degree of underlying vascular disease. We present an unusual case of treatment-resistant and eventually fatal soft tissue infection of the shoulder in a maintenance haemodialysis patient with known chronic lymphocytic leukaemia (CLL). We discuss the case with emphasis on the differential diagnosis of unusual soft tissue infections in a dialysis patient. We review possible causes of treatment failure, unusual organisms and implications for treatment.