Kuo Chih-Chun, Hsiao Po-Jen, Kuo Tai-You, Chiang Wen-Fang
Division of Endocrinology and Metabolism, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan 325011, Taiwan.
Division of Nephrology, Department of Medicine, Armed Forces Taoyuan General Hospital, Taoyuan 325011, Taiwan.
Reports (MDPI). 2024 Feb 1;7(1):9. doi: 10.3390/reports7010009.
Cold abscess of the chest wall is an uncommon disease that is mainly caused by tuberculous infection. Staphylococcal cold abscesses of the chest wall are extremely rare and usually clinically occult, frequently leading to a delay in diagnosis and consequently severe infectious complications. We report an 88-year-old woman with end-stage renal disease, who presented with an exit site infection of a cuffed tunneled dialysis catheter caused by methicillin-resistant (MRSA). Despite the removal of the catheter and administration of antibiotics, she developed refractory MRSA bacteremia. Computed tomography (CT) of the chest revealed septic thrombophlebitis with metastatic cold abscesses of the chest wall and ribs destruction. Although CT-guided drainage and vancomycin therapy eliminated MRSA bacteremia, the chest wall abscesses did not resolve. Patients fitted with a central venous dialysis catheter are at risk of septic thrombophlebitis with metastatic cold abscesses of the chest wall that are resistant to antibiotic therapy. Early identification is based on serial blood cultures and prompt CT scans. Surgical management coupled with antibiotic therapy can eradicate the source of infection and improve patients' outcomes.
胸壁寒性脓肿是一种罕见疾病，主要由结核感染引起。胸壁葡萄球菌性寒性脓肿极为罕见，通常在临床上隐匿，常常导致诊断延迟，进而引发严重的感染并发症。我们报告一名88岁的终末期肾病女性，她因耐甲氧西林金黄色葡萄球菌（MRSA）导致带袖套隧道式透析导管出口部位感染。尽管拔除了导管并给予抗生素治疗，但她仍发生了难治性MRSA菌血症。胸部计算机断层扫描（CT）显示有脓毒性血栓性静脉炎，伴有胸壁转移性寒性脓肿和肋骨破坏。尽管CT引导下引流和万古霉素治疗消除了MRSA菌血症，但胸壁脓肿并未消退。装有中心静脉透析导管的患者有发生脓毒性血栓性静脉炎并伴有对抗生素治疗耐药的胸壁转移性寒性脓肿的风险。早期识别基于连续血培养和及时的CT扫描。手术治疗联合抗生素治疗可根除感染源并改善患者预后。
