Case 374

Medical History

A 38 years-old male patient with hypertension, diabetes and undergoing renal replacement therapy with hemodialysis through femoral catheterization is admitted with arthralgia, pain and swelling in the right thigh. Physical examination of the patient reveals a poor general status, conscious, feverish, dyspneic and with chills. The patient has an important pre-sternal bulging and cervical and inguinal lymphadenopathy. The medical team orders blood-cultures and computed tomography of the thorax (Images 1 to 4).

Considering the clinical history and the imaging exams presented, what is the most likely diagnosis and the most appropriate initial therapeutic approach?

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