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Despite persistently negative conventional cultures, metagenomic next-generation sequencing (NGS) of pre-dialysis blood samples identified <jats:italic>Pseudomonas aeruginosa<\/jats:italic> (<jats:italic>P. aeruginosa<\/jats:italic>), <jats:italic>Cutibacterium acnes<\/jats:italic> (<jats:italic>C. acnes;<\/jats:italic> formerly <jats:italic>Propionibacterium acnes<\/jats:italic>), <jats:italic>Staphylococcus epidermidis<\/jats:italic> (<jats:italic>S. epidermidis<\/jats:italic>), <jats:italic>and Corynebacterium accolens<\/jats:italic> (<jats:italic>C. accolens<\/jats:italic>) and Epstein-Barr virus (EBV), while post-dialysis samples revealed only <jats:italic>C. acnes<\/jats:italic> and EBV. Given the temporal association with fever, these two pathogens were considered the primary causative agents. Subsequent transesophageal echocardiography (TEE) confirmed aortic valve vegetations, establishing the diagnosis of infective endocarditis (IE). Following targeted antimicrobial and antiviral adjustments based on NGS findings, the patient exhibited complete resolution of post-dialysis fever and was discharged. However, as the vegetation was not surgically removed, he was hospitalized multiple times over the following five months for recurrent infections and ultimately died of septic shock and multi-organ failure due to carbapenem-resistant <jats:italic>Klebsiella pneumoniae<\/jats:italic>.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Conclusions<\/jats:title>\n            <jats:p>This case underscores the complementary role of TEE and NGS in diagnosing IE in high-risk patients, enabling the detection of uncommon pathogens and informing targeted therapy to improve clinical outcomes.<\/jats:p>\n          <\/jats:sec>\n          <jats:sec>\n            <jats:title>Clinical trial number<\/jats:title>\n            <jats:p>Not applicable.<\/jats:p>\n          <\/jats:sec>","DOI":"10.1186\/s12882-025-04236-7","type":"journal-article","created":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T12:30:24Z","timestamp":1751373024000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["The complex diagnosis of post-dialysis fever: a case report and literature review of infective endocarditis in a dialysis patient"],"prefix":"10.1186","volume":"26","author":[{"given":"Xinyu","family":"Wang","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yu","family":"Xie","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Meiyu","family":"Chen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Hongyan","family":"Zhu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Guonian","family":"He","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Wenjing","family":"Yu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dan","family":"Qiao","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ying","family":"Shen","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Lu","family":"Song","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Qinyuan","family":"Deng","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"297","published-online":{"date-parts":[[2025,7,1]]},"reference":[{"issue":"2","key":"4236_CR1","first-page":"109","volume":"1","author":"A Davenport","year":"2008","unstructured":"Davenport A. 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