Research Article

Embolic Septic Emboli with MRSA: A different source

Christian Castillo Latorre*, Mariela Rivera Agosto, Ilean Lamboy Hernandez, Mariana Mercader Perez, Dominic Sanchez Paredes, Marisol Santiago Irizarry, Jose Gutierrez Nuñez Onix, Cantres Fonseca, Alfonso Torres Palacios and William Rodriguez Cintron

Published: 12/12/2019 | Volume 4 - Issue 1 | Pages: 044-047

Abstract

Septic Iliac vein thrombophlebitis with associated psoas abscess is a rare and severe entity, which diagnosis is challenging when no risk factor is clearly present. We are presenting a case of severe septic cavitary pulmonary emboli complicated with Acute Respiratory Distress Syndrome (ARDS) that evolved rapidly to respiratory distress and multi organ failure.
A 61-year-old Hispanic male, had multiple emergency department visits due to back pain, being most of them intramuscular pain medications and steroids. In the history, he had back pain that worsened accompanied by poor mobility, generalized malaise, fever and chills. Computed tomography (CT) scan showed a paravertebral psoas abscess with L5 - S1 diskitis/spondylitis inflammatory changes, which was then later evidenced by a gallium study. Further imaging studies were done, showed bilateral cavitary lung lesions, consistent with septic emboli. Subsequent blood cultures were positive for Methicillin Resistant Staphylococcus Aureus (MRSA), for which a successful combined therapeutic regimen was used. Transthoracic and transesophageal echocardiogram were not suggestive of endocarditis. Staphylococcus aureus (SA) bacteremia is one of the most common serious bacterial infections with a high risk of metastatic complications, which makes this pathogen a unique one. The combination of factors iliac vein thrombophlebitis, psoas muscle abscess, diskitis/spondylitis with ARDS makes cavitary pulmonary disease a challenging perspective. After a 6-week antimicrobial treatment, full anticoagulation, his clinical condition and image findings improved, and he was recently admitted for physical rehabilitation. Major vessels thrombophlebitis should always be considered, when primary source of septic pulmonary emboli is not clear. This case illustrates the complexity of illness and complications that may arise from a source of infection as the one in this patient. Further therapeutic strategies were tailored accordingly.

Read Full Article HTML DOI: 10.29328/journal.jcicm.1001026 Cite this Article

References

  1. Losno RA, Vidal-Sicart S, Grau JM. Multiple pyomyositis secondary to septic thrombophlebitis. Med Clin (Barc). 2019; 152: 515-516. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/30340839
  2. Stawicki SP, Firstenberg MS, Lyaker MR, Russell SB, Evans DC, et al. Septic embolism in the intensive care unit. Int J Crit Illn Inj Sci. 2013; 3: 58-63. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23724387
  3. Ye R, Zhao L, Wang C, Wu X, Yan H. Clinical characteristics of septic pulmonary embolism in adults: A systematic review. Respir Med. 2013; 108: 1-8. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/24183289
  4. Cook RJ, Ashton RW, Aughenbaugh GL, Ryu JH. Septic pulmonary embolism: presenting features and clinical course of 14 patients. Chest. 2005; 128: 162-166. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/16002930
  5. Baddour LM, Wilson WR, Bayer AS, Fowler VG Jr, Tleyjeh IM, et al. Infective endocarditis in adults: diagnosis, antimicrobial therapy, and management of complications: a scientific statement for healthcare professionals from the American Heart Association. Circulation. 2015; 132: 1435-1486. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/26373316
  6. Greaves K, Mou D, Patel A, Celermajer DS. Clinical criteria and the appropriate use of transthoracic echocardiography for the exclusion of infective endocarditis. Heart. 2003; 89: 273-275.
  7. Green RS, Travers AH, Cain E, Campbell SG, Jensen JL, et al. Paramedic Recognition of Sepsis in the Prehospital Setting: A Prospective Observational Study. Emerg Med Int. 2016; 2016; 2016.
  8. Prnjavorac B, Sejdinovic R, Jusufovic E, Mehic J, Bedak O, et al. Septic pulmonary embolisms as a cause of acute respiratory distress syndrome. Euro Respiratory J. 2016; 48.
  9. Kuhlman JE, Fishman EK, Teigen C. Pulmonary septic emboli: Diagnosis with CT. Radiology. 1990; 174: 211-213. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/2294550
  10. Kniemeyer HW, Grabitz K, Buhl R, Wüst HJ, Sandmann W. Surgical treatment of septic deep venous thrombosis. Surgery. 1995; 118: 49-53. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/7604379
  11. Zuo LE, Guo S. Septic pulmonary embolism in intravenous drug users. Chin J Tuberc Respir Dis 2007; 30: 569-572. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/17988547
  12. Brenes JA, Goswami U, Williams DN. The association of septic thrombophlebitis with septic pulmonary embolism in adults. Open Respir Med J. 2012; 6: 14-19. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/22611460
  13. Mara Lambert. IDSA Guidelines on the Treatment of MRSA Infections in Adults and Children. Am Fam Physician. 2011; 84: 455-463.
  14. Shah S, Barton G, Fischer A. Pharmacokinetic considerations and dosing strategies of antibiotics in the critically ill patient. J Intensive Care Soc. 2015; 16: 147-153. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/28979397
  15. Hodgson CL, Capell E, Tipping CJ. Early Mobilization of Patients in Intensive Care: Organization, Communication and Safety Factors that Influence Translation into Clinical Practice. Crit Care. 2018; 22: 77. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/29558969
  16. Brummel NE, Girard TD. Preventing delirium in the intensive care unit. Crit Care Clin. 2013; 29: 51-65. PubMed: https://www.ncbi.nlm.nih.gov/pubmed/23182527