A Rare but Ominous Association: Intracardiac Thrombus and Vegetation Simultaneously in a Hemodialysis Patient

A 74-year-old woman with metastatic endometrium cancer presented with complaints of nausea and vomiting. She was commenced on hemodialysis due to acute renal failure via a right jugular central venous catheter (CVC). We also administered enoxaparine as deep qvein thrombosis prophylaxis. She developed fever during the course of hospitalization. Two sets of blood cultures yielded methicillin-resistant Staphylococcus aureus. qEnoxaparine was stopped due to thrombocytopenia. We administered appropriate broad-spectrum antibiotics; however, she remained febrile after 72 hours. We found that the patient developed swelling and redness in the right calf, in which Doppler ultrasound revealed acute deep vein thrombosis. Transthoracic echocardiography depicted a mobile thrombus in the right atrium, which was moving in and out of the right ventricle.