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Abstract
Persistent methicillin-resistant Staphylococcus aureus bacteremia (PMRSAB) has recently become a serious problem in patient care. However, it is an unusual complication of peripheral thrombophlebitis. An 80-year-old woman with head trauma suffered from suppurative thrombophlebitis on the insertion site of a peripheral venous catheter of her right wrist. She died of septic shock following fatal PMRSAB. Autopsy was requested to evaluate the extent of the infection, and disclosed septic thrombophlebitis with abscess formation in the right wrist and infective endocarditis on the leaflets of mitral valve.
Figures and Tables
Figure 1
The clinical course of the patient with persistent methicillin-resistant Staphylococcus aureus (MRSA) bacteremia.
CRP, C-reactive protein; avancomycin trough level.
Figure 2
Internal view of the wrist shows liquefied materials below the insertion site of intravenous line (A: Gross photo). Histologic finding of the skin shows dermal hemorrhages and subcutaneous abscess (arrow) (B: H&E stain, ×40). Many neutrophils in necrotic tissue are observed in abscess. (C: H&E stain, ×200)
Figure 3
Multiple variable-sized friable vegetations (arrow) are noted on the leaflets of mitral valve (A: Gross photo). Microscopically, the vegetations consist of neutrophils and bacterial colonies (arrows) (B: H&E stain, ×100). Myocardium shows marked suppurative inflammation by neutrophils (C: H&E stain, ×200).
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