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Catheter-related sepsis Extraluminal catheter thrombosis Fraxiparin Hemodialysis M Pilar Ruiz-Valverde, MD, Nephrology Unit, Hospital General ‘Vail d’Hebron’, Paseo Vail d’Hebron, s/n, E-08035 Barcelona (Spain) Introduction The main complications associated with the use of central venous catheters for hemodialysis are infections and thrombosis [1-3]. Both may be the reason for undesired catheter removal. In a previous study we showed that catheter-related sepsis may be diagnosed and treated successfully without removing it, provided the infection was not associated with a catheter thrombosis. We report a patient who suffered from catheter-related sepsis complicated with an extraluminal distal catheter thrombosis and who was successfully treated with fraxiparin and systemic and local antibiotic therapy, with the catheter being maintained in place. Case Report A 31-year-old woman with chronic renal insufficiency secondary to a diabetic nephropathy was admitted to another hospital because of fever and malaise. She had been on hemodialysis for 5 months through an internal jugular catheter implanted surgically (Perm-cath®). Blood cultures were positive for Staphylococcus epidermidis and the patient was treated with intravenous cloxacillin (2 g/4 h). No echocardiographic study was done. After a 2-week antibiotic treatment, the clinical response was good and blood cultures became negative. Two months later, the patient was feverish and blood cultures were positive for S. epidermidis again. She was treated with two doses of vancomycin (15 mg/kg i.v.) administered every 7 days. Two weeks later, she still had fever and was referred to our hospital. The patient was in good general condition, and the physical and complementary investigations did not evidence an infective site. The blood cultures and serologic studies for Brucella melitensis, Salmonella typhi, cytomegalovirus, herpesvirus, Legionella pneumophila, Chlamydia