Successful treatment of disseminated cerebritis complicating methicillin-resistant Staphylococcus aureus Endocarditis unresponsive to vancomycin therapy with linezolid.

A unique case of community acquired methicillin resistant Staphylococcus aureus (MRSA) sepsis, with endocardial and cerebral metastatic seeding, caused by a strain representative of the Italian clone, is described. The patient was a 47-y-old man without apparent risk factors for endocarditis and for MRSA infection who developed coma with multiple cerebritis lesions under vancomycin plus amikacin therapy. He was eventually cured with the addition of linezolid to the initial antimicrobial regimen. This observation seems to confirm previous reports of the efficacy of linezolid for the treatment of central nervous system infections caused by multidrug resistant Gram-positive bacteria. To our knowledge, this is the first report of MRSA disseminated cerebritis, a nearly always fatal disease, cured with this oxazolidinone drug. The increase in community acquired MRSA may have some impact on empirical treatment of serious infections caused by this organism.

Arthritis as a rare side effect of phenytoin therapy.

Anticonvulsant hypersensitivity syndrome is an uncommon side effect of phenytoin. It is characterized by fever, skin reactions, lymphadenopathy, and severe multiorgan involvement. Atypical clinical features have rarely been described. We observed a unique case of anticonvulsant hypersensitivity syndrome in a 77-year-old woman in whom fever and monoarthritis were the main clinical features. Symptoms dramatically subsided after phenytoin withdrawal.