Keep an Eye on the Eye Symptoms of Your Dialysis Patient

A 73-year-old man with a history of end-stage renal disease (on hemodialysis for 6 years), hypertension, and diabetes mellitus type 2 presented with worsening pain and swelling of the left upper extremity brachiocephalic arteriovenous fistula. The patient was having night sweats for a few days prior to presentation. He was started on intravenous cephalosporin therapy at his outpatient dialysis unit as the blood cultures grew Staphylococcus aureus. On examination, the fistula was hard, and there was skin degeneration with oozing in the area which appeared to be a pseudoaneurysm (Figure, left panel).