CASE OF DISSEMINATED STAPHYLOCOCCAL INFECTION
A fifteen years old boy was referred to me for evaluation of persistent fever. Two months before he had gone to his native town. Few days later he developed chickenpox but recovered soon. After few days he had new onset of fever spikes associated with left sided low back pain. He had no other abnormal medical history and was not on any long term medications. One day he complained severe pain in right shoulder. He was unable to lift that arm. His fever spikes continued even though he recovered from chickenpox. The family traveled back to Ahmedabad and got him admitted to a hospital. Later on he was referred to me. He was febrile and weak and was barely able to walk. Though he never complained, when I examined him, he had severe tenderness on his left buttock too. His X ray of right shoulder done before was normal.
Such kind of unusual presentation involving more than one joint can occur in few conditions like disseminated infection, autoimmune diseases, cancer etc. Looking to the event of Chickenpox, I suspected deep seated infection. I advised MRI scan of right shoulder, spine and left gluteal region. His blood culture, the test to find out the species of invading organism, was ordered. I also sent investigations to rule out autoimmune disease. His MRI of left gluteal region suggested multiple collections of fluid within and surrounding muscles of hip joint. MRI of spine suggested swelling in lower vertebras and swelling of a joint in the pelvic bone (Secro-Iliac joint). His MRI of right shoulder also suggested similar collections and severe damage to one of the muscles of his shoulder joint. The fluid within the pockets was aspirated and sent for evaluation of the organisms involved but did not revealed any organism. His blood culture report sent two days before became available now. It suggested a very dangerous organism MRSA (methicillin Resistant Staphylococcus Aureus). This is a notorious organism that invades in to the blood through a breach in the skin. This boy had chickenpox. The blisters of the chickenpox eroded the skin and paved way for the organisms to enter his blood stream. In the blood the organisms escaped his immune system and multiplied, travelled and settled at regions of spine, left hip and right shoulder and created multiple abscesses. If effective treatment not initiated soon, his joints may get permanently damaged.
Viral infections perturbs immune system and creates opportunity for other organisms to grow in various parts of our body. Disseminated infections may prove fatal if appropriate antibiotics are not infused soon. However suspecting this organism, I had initiated effective antibiotics much before the organism was identified.
He responded well to the appropriate antibiotic treatment. Fever subsided after three days and pain in right shoulder disappeared completely. After a week of treatment was able to walk without pain. His appetite improved. Now he was able to perform his daily activities without support. He was discharged before two weeks with further instructions. He did well at home. He came for the follow up after two weeks. Repeat MRI showed significant improvement compared to previous scan.
