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Case Reports
. 2022 Dec 26;10(36):13418-13425.
doi: 10.12998/wjcc.v10.i36.13418.

Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis: A case report

Yu Chen  1 , Dian Chen  2 , Hao Liu  3 , Chen-Guang Zhang  1 , Lin-Lin Song  4
Affiliations
Case Reports

Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis: A case report

Yu Chen et al. World J Clin Cases. .

Abstract

Background: Staphylococcus aureus bacteraemia (SAB) is among the leading causes of bacteraemia and infectious endocarditis. The frequency of infectious endocarditis (IE) among SAB patients ranges from 5% to 10%-12%. In adults, the characteristics of epidermolytic hyperkeratosis (EHK) include hyperkeratosis, erosions, and blisters. Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cell-mediated immunity.

Case summary: We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases. After genetic tests, the skin disease was diagnosed as EHK.

Conclusion: A breached skin barrier secondary to EHK, coupled with inadequate sanitation, likely provided the opportunity for bacterial seeding, leading to IE and deep-seated abscess or organ abscess. EHK may be associated with skin infection and multiple risk factors for extracutaneous infections. Patients with EHK should be treated early to minimize their consequences. If patients with EHK present with prolonged fever of unknown origin, IE and organ abscesses should be ruled out, including metastatic spreads.

Keywords: Case report; Epidermolytic hyperkeratosis; Infective endocarditis; Staphylococcus aureus bacteremia.

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Conflict of interest statement

Conflict-of-interest statement: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.

Figures

Figure 1
Figure 1
Images of the skin lesions. Diffuse palmoplantar hyperkeratosis, erythema, and scales on the flexor surfaces of both arms and lower limbs. A: Palms; B: Opisthenar; C: Arms; D: Planta pedis; E: Dorsum of the foot.
Figure 2
Figure 2
Computed tomography. A and B: Cranial computed tomography showing multiple low-density shadows (blue arrow, A and B) in the brain; C and D: Abdominal enhanced CT scan showing multiple low-density shadows (green arrow, C and D) in the spleen, considered a splenic abscess with subcapsular effusion.
Figure 3
Figure 3
Transesophageal echocardiography. A and B: The anterior leaflet of the mitral valve was detected with a wart (white arrow) of a cord-like medium echoic substance about 10mm and the posterior leaflet was detected with the wart (white arrow) of a medium echoic substance about 7 mm × 7 mm; C and D: There was severe mitral regurgitation and the regurgitation bundle was distributed along the posterior leaflet of the mitral valve. There was mild tricuspid valve and the aortic valve regurgitation.
Figure 4
Figure 4
Histopathological, and genetic features of the patient. A and B: The c.539A>G mutation was detected in KRT1; C: The pathological examination indicated epidermal hyperkeratosis, acantholysis and lymphocytes infiltrating the superficial dermis around blood vessels and adjuncts (H&E stain, original magnification 100×); D: c.539A>G detection using Next Generation Sequencing and Sanger sequencing.
See this image and copyright information in PMC

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