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Septic pulmonary emboli and bacteraemia from an oral mucosal abscess caused by methicillin-resistant Staphylococcus aureus

Vijay Chander Vinod, Asif Satar
Published in : HAMDAN MEDICAL JOURNAL ; Vol 7, No 2 (2014)
DOI : 10.7707/hmj.v7i2.247


A 26-year-old woman was admitted to the emergency department at Mediclinic City Hospital, Dubai, United Arab Emirates (UAE), with complaints of fever, cough and pleuritic chest pain. She had a history of asthma that had been well controlled and she had been taking co-amoxiclav (Augmentin®, GlaxoSmithKline) for the 3 days prior to admission, for treatment of an oral abscess. Her vital parameters were tested on admission, a full blood count was taken and a C-reactive protein test and chest radiography were performed. She was started on intravenous (i.v.) ceftriaxone in the emergency department, pending the results of the blood culture, and was then transferred to the medical ward. Over the next 24 hours, the patients condition deteriorated and her temperature did not stabilize. She complained of worsening pleuritic chest pain; thus, chest radiography was repeated and showed worsening right middle lobe consolidation and left pleural effusion. Computed tomography (CT) of the thorax was performed and showed multiple thick-walled cavitating nodules that mainly occupied the periphery of both lungs with left lower lobe consolidation and bilateral pleural effusion. The results of the tests were consistent with a diagnosis of septic pulmonary embolism. Her blood cultures tested positive for methicillin-resistant Staphylococcus aureus (MRSA) but were sensitive to vancomycin, linezolid (Zyvox®, Pfizer) and clindamycin, and MRSA was also cultured from the pus drained from the abscess on the patients face. She was prescribed i.v. vancomycin and within 48 hours her temperature and clinical condition improved considerably. The patient then completed 10 days of i.v. vancomycin as an in-patient and was discharged with a prescription for oral doxycycline for 1 week. She had a follow-up appointment in the clinic 2 weeks after her discharge, at which time she was asymptomatic and repeat CT of the thorax showed considerable improvement


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