Community-Acquired Mecithillin-Resistant Staphylococcus Aureus : A Case Report on Necrotizing Fasciitis And Deep Vein Thrombosis In Adolescent Boy

Abstract

Staphylococcus aureus (S. Aureus) is the most common species of staphylococci to cause Staph infections. The infections caused by S. aureus were not difficult to manage. However, in recent past, S. aureus is transformed to its variant forms, including, Methicillin-resistant S. aureus (MRSA) by acquiring methicillin resistant gene (mec A gene). Previously, the MRSA was known for its origin from hospitals, but more recently, it is known to be acquired, from the communities too. Here we report the case presentation of a male adolescent with complicated fibular osteomyelitis, necrotizing fasciitis and deep vein thrombosis caused by Community acquired (CA) MRSA. The preliminary complaint of the patient was swelling in right foot and leg associated with high fever, pain, dyspnea and cough. The clinical presentation fit him as acute respiratory distress syndrome and hence antibiotics (ceftixone and vancomycin) were started. Doppler ultrasound revealed deep vein thrombosis (DVT). Analysis of blood culture showed the presence of MRSA. Hence rifampin and gentamicin were added and ceftrixon was discontinued. MRI revealed ostiomyelitis in the distal part of fibula. The bone infection was so severe that despite of using the three antibiotics, the patient remained febrile with increased leukocytes and neutrophills, the ankle redness became confined with malleollus on each side and the sepsis remained uncontrollable. Repeated MRI showed inflammatory findings, including cellulitis, pyogenic myositis, deep fasciitis and fibular periosteal reactions, suggestive of necrotizing fasciitis. Upon confirmation of fasciitis, fasciotomy with debridement and irrigations was done in multiple sessions and a high dose intravenous immunoglobulin was administered as an adjuvant therapy, resulting in reversal of the disease progression. In light of reports in the literature, we replaced antibiotics with immunoglobulins as a post surgery treatment, which worked well.