Abscess formation following secondary migration of peripherally inserted central catheter in a neonate: a case report and review of literature.

Introduction: Peripherally inserted central catheters (PICCs) are widely used for long-term intravenous access in neonatal intensive care units (NICUs). Although generally safe, PICC-related complications can occasionally be serious. Abscess formation is a rare but significant event. This report describes a preterm neonate who developed a left flank abscess secondary to PICC line migration, emphasizing the importance of meticulous monitoring of catheter position and related complications. Case presentation: A preterm twin neonate born at 32 weeks was admitted to the NICU with respiratory distress syndrome. A PICC line was placed for parenteral therapy. On day 30, the infant developed lethargy and feeding intolerance, and sepsis work-up revealed infection. Despite antibiotic therapy, a warm, erythematous swelling appeared on the left flank. Imaging showed a large abscess with an air-fluid level, with the PICC tip located within the collection. The infant received Linezolid and Colistin, followed by surgical drainage, which yielded pus. Clinical improvement ensued and the neonate was discharged after completing antibiotic therapy. Follow-up imaging confirmed complete resolution. Discussion: PICC complications include secondary migration - reported in 4-12% of cases - which may lead to severe infections. In this case, secondary migration likely caused abscess formation, despite correct initial placement. Conclusion: This case highlights that even when initially positioned correctly, PICCs require continuous monitoring to detect potential migration and associated complications. Enhanced awareness, routine imaging reassessment, and standardized follow-up protocols can improve safety and outcomes in neonatal PICC management.