Ohta Ryuichi, Shigetaka Tomohiro, Sano Chiaki
Community Care, Unnan City Hospital, Unnan, JPN.
Orthopedic Surgery, Unnan City Hospital, Unnan, JPN.
Cureus. 2023 Dec 20;15(12):e50815. doi: 10.7759/cureus.50815. eCollection 2023 Dec.
This case report describes an 86-year-old female patient who presented with complex post-surgical complications following orthopedic surgery for a femoral neck fracture. Initially diagnosed with septic shock due to methicillin-resistant (MRSA) bacteremia at the surgical site, the patient's treatment course was complicated, involving multiple hospital transfers and varying treatments, including antibiotics and surgical drainage. Despite the absence of infection indicators post treatment, the patient later developed severe thigh pain and was found to have migratory pseudogout, an unusual diagnosis in the context of MRSA and post-surgical complications. This report emphasizes the diagnostic challenges in distinguishing between surgical site infections and other inflammatory conditions like migratory pseudogout, particularly in older patients with comorbidities. It underscores the importance of comprehensive evaluations and the need for general physicians to maintain a broad differential diagnosis when managing post-surgical infections. The case highlights the persistence and recurrence risk of MRSA infections, even post-appropriate antibiotic therapy, and the necessity of considering migratory pseudogout in patients with recurrent infections and systemic soft tissue involvement. The insights from this case contribute to the understanding of complex post-surgical complications and advocate for meticulous assessment and tailored treatment strategies in similar clinical scenarios.
本病例报告描述了一名86岁女性患者,她在接受股骨颈骨折骨科手术后出现了复杂的术后并发症。该患者最初被诊断为手术部位耐甲氧西林金黄色葡萄球菌(MRSA)菌血症导致的感染性休克,其治疗过程复杂,包括多次转院和多种治疗方法,如使用抗生素和手术引流。尽管治疗后感染指标消失,但患者后来出现了严重的大腿疼痛,并被发现患有游走性假性痛风,这在MRSA和术后并发症的背景下是一种不寻常的诊断。本报告强调了在区分手术部位感染和其他炎症性疾病(如游走性假性痛风)时所面临的诊断挑战,尤其是在患有合并症的老年患者中。它强调了全面评估的重要性,以及全科医生在处理术后感染时保持广泛鉴别诊断的必要性。该病例突出了MRSA感染的持续性和复发风险,即使在进行了适当的抗生素治疗后也是如此,以及在患有复发性感染和全身性软组织受累的患者中考虑游走性假性痛风的必要性。该病例的见解有助于理解复杂的术后并发症,并倡导在类似临床情况下进行细致的评估和量身定制的治疗策略。