Chaudhary Dhruv, Subhash Amith, Galvis Juan, Guardiola Juan
University of Louisville, Louisville, Kentucky, USA.
Department of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
BMJ Case Rep. 2017 Jan 30;2017:bcr2016218468. doi: 10.1136/bcr-2016-218468.
Methicillin-resistant Staphylococcus aureus (MRSA) necrotising fasciitis (NF) is rare and constitutes a medical and surgical emergency. We report a case of a 53-year-old man with type-2 diabetes mellitus and newly diagnosed HIV infection who presented with 1 week of progressively worsening bilateral sharp thigh pain. On presentation, he was febrile, tachycardic and had bilateral thigh erythema and mild tenderness without open wounds. He had leucocytosis, lactic acidosis and acute kidney injury. Urgent incision and drainage (I&D) was performed for suspected NF. Blood cultures and I&D were positive for MRSA. Biopsy of bilateral thighs showed NF. He was treated with wound washout and 6 weeks of intravenous antibiotics. After undergoing skin graft for wounds, he was discharged to physical rehabilitation. Here we report severe sepsis from bilateral thigh MRSA NF in a patient with newly diagnosed HIV.
耐甲氧西林金黄色葡萄球菌（MRSA）坏死性筋膜炎（NF）较为罕见，是一种医疗和外科急症。我们报告一例53岁男性病例，该患者患有2型糖尿病且新诊断出感染HIV，出现双侧大腿剧痛进行性加重1周。就诊时，他发热、心动过速，双侧大腿有红斑且轻度压痛，无开放性伤口。他存在白细胞增多、乳酸酸中毒和急性肾损伤。因怀疑NF进行了紧急切开引流（I&D）。血培养和I&D结果显示MRSA阳性。双侧大腿活检显示为NF。他接受了伤口冲洗及6周静脉抗生素治疗。伤口进行皮肤移植后，出院接受物理康复治疗。在此我们报告一例新诊断HIV患者双侧大腿MRSA NF导致的严重脓毒症。
