Bacteraemia-associated Hypertensive Response, a Case (Report) for the Inflammation/hypertension Axis

Abstract

Abstract Background: Hypertensive crises are life-threatening conditions that can be associated with organ damage including acute heart failure, intracerebral haemorrhage, seizures and coma and are common in dialysis patients. Case Presentation: We report a case of a sudden onset of repeated episodes of hypertensive crises in a young dialysis patient. Surprisingly, we found a catheter-associated Pseudomonas aeruginosa-infected right atrial thrombus and smouldering endocarditis to be the cause for these exacerbations in blood pressure. Anti-hypertensive therapy did not suffice to control critical surges of blood pressure particularly at dialysis. An anti-infective approach comprising antibiotics, catheter removal and finally extraction of the thrombus by open-heart surgery led to resolution of severe hypertension. Conclusions: This case contradicts canonical assumptions that severe infections with bacteraemia unambiguously lead to hypotension introducing the septic vicious cycle. The specific characteristics of the case (remitting hypertensive crisis while the thrombus experienced shear stress at dialysis, supposedly leading to bacterial antigen flooding and resolution of hypertension after thrombus removal) support the hypothesis that infection was the decisive cause of severe hypertension here. With that, albeit naturally anecdotally, this case might serve as a hint that infection can be causative for hypertension or amplifying it. Thus, this case emerges as premier direct evidence for the substantiation of the increasingly well-established hypertension/inflammation axis.