Non Lemuel, Kosmin Aaron
Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
Department of Infectious Diseases, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
BMJ Case Rep. 2015 Mar 30;2015:bcr2014206848. doi: 10.1136/bcr-2014-206848.
Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a rare cause of necrotising fasciitis (NF), and is usually not fulminant as in group A Streptococcus (GAS), the archetypal aetiology. We report an unusually fulminant case of NF by CA-MRSA in an immunocompetent patient. A 52-year-old man presented to the emergency department with 1 week of progressive left thigh pain and swelling. The patient had ecchymoses, bullae and hypoesthesia of the involved skin, and CT scan revealed extensive fascial oedema. He was immediately started on broad spectrum antibiotics. Within 12 h of presentation, he underwent surgical debridement. Despite aggressive supportive care, the patient died less than 24 h after presentation. MRSA, with an antibiogram suggestive of a community-acquired strain, was recovered from intraoperative specimens and admission blood cultures. This case underscores that CA-MRSA, while rarely reported, can cause a fulminant presentation of NF similar to GAS in immunocompetent patients.
社区获得性耐甲氧西林金黄色葡萄球菌（CA-MRSA）是坏死性筋膜炎（NF）的罕见病因，通常不像典型病因A组链球菌（GAS）那样呈暴发性。我们报告了1例免疫功能正常患者由CA-MRSA引起的异常暴发性NF病例。一名52岁男性因左大腿进行性疼痛和肿胀1周就诊于急诊科。患者受累皮肤有瘀斑、大疱和感觉减退，CT扫描显示广泛的筋膜水肿。他立即开始接受广谱抗生素治疗。就诊后12小时内，他接受了手术清创。尽管给予了积极的支持治疗，但患者在就诊后不到24小时死亡。术中标本和入院血培养分离出MRSA，其抗菌谱提示为社区获得性菌株。该病例强调，CA-MRSA虽然报道较少，但在免疫功能正常的患者中可引起类似于GAS的暴发性NF表现。
