Fulminant methicillin-sensitive Staphylococcus aureus infection: from pinprick to multiorgan failure.

A woman in her 60s with diabetes presented to our institution with altered mental status. Preceding symptoms included headaches, nausea and vomiting. One month prior to presentation, she cut her left thumb and developed a pustule, which she occasionally manipulated with a non-sterile needle. On arrival, the patient was in shock, with a Glasgow Coma Scale of 3, requiring emergent intubation and intensive care unit admission. Her initial imaging studies revealed a large pericardial effusion and cerebral subcortical hypodensities. She suffered from a cardiopulmonary arrest with return of spontaneous circulation, with bedside echocardiogram revealing cardiac tamponade. She underwent emergent pericardiocentesis which revealed purulent drainage. Blood, pericardial fluid, cerebrospinal fluid, sputum and urine cultures returned positive for methicillin-sensitive Staphylococcus aureus The hospital course was further complicated by refractory septic shock and fulminant multiorgan failure, ultimately leading to her demise.

Laparoscopic diagnosis and repair of Spigelian hernia: A case report and literature review.

INTRODUCTION: Spigelian hernias are a rare type of hernia which protrude through the abdominal wall at the semilunar line. They are especially difficult to diagnose due to their location and non-specific symptoms and are often overlooked because of their positioning between muscular layers. Patients may present with localized pain which can aid the diagnosis. CT and ultrasound are also helpful. PRESENTATION OF CASE: We present the case of a 75-year-old female patient who presented to Hialeah Hospital with a one-year history of abdominal pain localized to the left lower quadrant. DISCUSSION: A Spigelian hernia containing omentum, was found during a diagnostic laparoscopy. The hernia was reduced, and the abdominal defect was repaired via primary repair, reinforced by mesh. The patient recovered uneventfully. CONCLUSION: Nonspecific physical exam findings and inconclusive imaging studies represented a diagnostic challenge. Here we discuss a case of a Spigelian hernia discovered through diagnostic laparoscopy.