Internal Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA
Internal Medicine, Aventura Hospital and Medical Center, Aventura, Florida, USA.
BMJ Case Rep. 2021 May 11;14(5):e239396. doi: 10.1136/bcr-2020-239396.
A woman in her 60s with diabetes presented to our institution with altered mental status. Preceding symptoms included headaches, nausea and vomiting. One month prior to presentation, she cut her left thumb and developed a pustule, which she occasionally manipulated with a non-sterile needle. On arrival, the patient was in shock, with a Glasgow Coma Scale of 3, requiring emergent intubation and intensive care unit admission. Her initial imaging studies revealed a large pericardial effusion and cerebral subcortical hypodensities. She suffered from a cardiopulmonary arrest with return of spontaneous circulation, with bedside echocardiogram revealing cardiac tamponade. She underwent emergent pericardiocentesis which revealed purulent drainage. Blood, pericardial fluid, cerebrospinal fluid, sputum and urine cultures returned positive for methicillin-sensitive The hospital course was further complicated by refractory septic shock and fulminant multiorgan failure, ultimately leading to her demise.
一位 60 多岁的女性患有糖尿病，因精神状态改变到我院就诊。此前的症状包括头痛、恶心和呕吐。在出现症状前一个月，她割伤了左手拇指，出现了脓疱，她偶尔会用非无菌针进行处理。患者到达时处于休克状态，格拉斯哥昏迷评分为 3 分，需要紧急插管和重症监护病房入院。她的初始影像学研究显示大量心包积液和脑皮质下低密影。她发生心肺骤停，自主循环恢复，床边超声心动图显示心脏压塞。她接受了紧急的心包穿刺术，发现脓性引流。血液、心包液、脑脊液、痰和尿液培养均对甲氧西林敏感的 金黄色葡萄球菌 呈阳性。医院的病程进一步复杂化，出现难治性感染性休克和暴发性多器官衰竭，最终导致她死亡。
