Monteiro Nadine, Moleiro Filipa, Lérias Graça, Silva Alberto Mello
Department of Internal Medicine, Centro Hospitalar Lisboa Ocidental, EPE - Hospital Egas Moniz, Lisboa, Portugal.
BMJ Case Rep. 2015 Feb 18;2015:bcr2014208748. doi: 10.1136/bcr-2014-208748.
We report a case of a 74-year-old man who presented to the emergency department with a 1-week history of fever. He had a meatal stenosis and had a suprapubic catheter for 10 months, and had a recent hospitalisation for urosepsis with bacteraemia due to methicillin-resistant Staphylococcus aureus after manipulation of the catheter. Clinical examinations were performed in the emergency department and the patient was hospitalised with the diagnosis of recurrent urinary tract infection. The following day, we noticed the development of a mass in the left sternoclavicular joint with inflammatory signs and excruciating pain. Ultrasonographic findings led to the diagnosis of left sternoclavicular synovitis, and methicillin-resistant S. aureus grew in blood cultures leading to the diagnosis of sternoclavicular septic arthritis. Treatment with vancomycin and gentamicin was started and maintained for 4 weeks with complete resolution of symptoms and no complications or sequelae.
我们报告一例74岁男性,因发热1周就诊于急诊科。他患有尿道口狭窄,耻骨上留置导尿管10个月,近期因导尿管操作后发生耐甲氧西林金黄色葡萄球菌所致的菌血症性尿脓毒症而住院。在急诊科进行了临床检查,患者因复发性尿路感染诊断入院。次日,我们注意到左胸锁关节出现肿物,伴有炎症体征和剧痛。超声检查结果诊断为左胸锁关节滑膜炎,血培养中培养出耐甲氧西林金黄色葡萄球菌,从而诊断为胸锁关节化脓性关节炎。开始使用万古霉素和庆大霉素治疗并维持4周,症状完全缓解,无并发症或后遗症。