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Review
. 2014 Jan 9:7:21.
doi: 10.1186/1756-0500-7-21.

Methicillin-resistant Staphylococcus aureus enterocolitis sequentially complicated with septic arthritis: a case report and review of the literature

Affiliations
Review

Methicillin-resistant Staphylococcus aureus enterocolitis sequentially complicated with septic arthritis: a case report and review of the literature

Yukari Ogawa et al. BMC Res Notes. .

Abstract

Background: Although most reports describing patients infected with methicillin-resistant Staphylococcus aureus enterocolitis have been published in Japan, this concept remains a matter of debate and diagnostic criteria have not yet been defined.

Case presentation: The general status of a 74-year-old Japanese man referred to our hospital (day 1) with severe community-acquired pneumococcal pneumonia gradually improved with antibiotic therapy. Thereafter, up to 4 L/day of acute watery diarrhea that started on day 19 was refractory to metronidazole but responded immediately to oral vancomycin. Gram staining stool samples was positive for abundant fecal leukocytes from which dominant methicillin-resistant Staphylococcus aureus (10(4) CFU/mL) were isolated, suggesting methicillin-resistant Staphylococcus aureus enterocolitis. High fever with methicillin-resistant Staphylococcus aureus bacteremia was evident at day 30, and suppurative right hip arthritis developed around day 71. All methicillin-resistant Staphylococcus aureus strains isolated from stools, blood and aspirated synovial fluid separated in the same manner on pulsed-field gel electrophoresis, as well as two other strains isolated from sputum, belonged to the same clone as sequence type (ST) 764 (complex clonal 5), and carried SCCmec type II.

Conclusion: The clinical, microbiological and molecular biological findings of this patient indicated methicillin-resistant Staphylococcus aureus enterocolitis that led to septic methicillin-resistant Staphylococcus aureus arthritis.

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Figures

Figure 1
Figure 1
Clinical course of the patient. Abbreviations: CLDM, clindamycin; CPFX, ciprofloxacin; DIV, drip infusion; LZD, linezolide; MEPM, meropenem; MRSA, methicillin-resistant Staphylococcus aureus; MZN, metronidazole; TEIC, teicoplanin; VCM, vancomycin.
Figure 2
Figure 2
Gram staining findings of stool cultures. Fecal leukocytes are abundant.
Figure 3
Figure 3
Magnetic resonance imaging of right hip joint. T2-weighted image (T2WI) of hip joint shows high-intensity area surrounding head of right femur, indicating fluid collection (A). Fat saturated T2WI shows high-intensity area on right obturator externus or adducent muscles (B) that appears as a hotspot on gallium scintigram (C). Synovial fluid contains abundant leukocytes that are phagocytically engulfed by gram-positive cocci (D).
Figure 4
Figure 4
Analysis of identified methicillin-resistant Staphylococcus aureus strains on pulsed-field gel electrophoresis. M, marker; 1, sputum (day 10); 2, stool (day 19); 3, intravenous hyperalimentation catheter (day 20); 4, blood (day 30); 5, sputum (day 44); 6, hip joint synovial fluid (day 100); C, control (Staphylococcus aureus, strain NCTC 8325).

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