MRSA Septic Polyarthritis: a case report and review of literature

ABSTRACT

A 45-year-old male patient with history of hypertension and diabetes mellitus was admitted to the hospital because of increasing erythema and swelling of left elbow, bilateral wrist, right knee and right ankle joints of two weeks duration. He had undergone amputation of his left big toe two months prior to presentation, which was complicated by wound infection and poor healing. He had been treated with multiple courses of empiric oral and intravenous antibiotics to control the local infection. On examination, the patient's temperature was 102 F, pulse rate was 90 beats per minute, and blood pressure was 160/90 mm Hg and respiratory rate 20 per minute. There was significant tenderness, swelling and erythema of both wrists. Left knee and ankle appeared markedly swollen and tender with severe limitation of movement. Left big toe wound looked infected with purulent drainage. Synovial fluid aspirate from right wrist and knee showed numerous pus cells and gram-positive cocci on Gram stain. The culture grew S. aureus resistant to methicillin but sensitive to vancomycin, teicoplanin, chloramphenicol and fusidic acid. Three consecutive blood cultures also grew colonies of S. aureus. Therefore the diagnosis of MRSA septic polyathritis was made