Despite a high incidence of Staphylococcus aureus bacteremia in hemodialysis patients, bacterial invasion with aortic wall infection resulting in a pseudoaneurysm rarely occurs. This report describes a case of mycotic pseudoaneurysm of the abdominal aorta that grew rapidly and ruptured into the distal vena cava causing persistent bacteremia in a patient undergoing hemodialysis complicated with oxacillin-resistant S. aureus bacteremia.