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PICTURES IN CLINICAL MEDICINE
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Persistent Staphylococcus aureus Bacteremia Po-Han Huang 1,2, Nai-Ching Chen 3, Tzung-Yo Ho 1,2 and Chien-Liang Chen 1,2 Key words: Staphylococcus aureus bacteremia, mycotic aneurysm (Intern Med 54: 541-542, 2015) (DOI: 10.2169/internalmedicine.54.3487)
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A 92-year-old man undergoing hemodialysis was admitted with a fever. A physical examination showed multiple scratched skin wounds, and blood cultures yielded methicillin-resistant Staphylococcus aureus (MRSA). Therapy with vancomycin was therefore initiated. Meanwhile, a transthoracic echocardiogram revealed no vegetation, and, after four weeks of therapy, the patient’s symptoms were relieved. However, despite this initial improvement, he was readmitted one week later for MRSA bacteremia, at which
time computed tomography (CT) angiography showed a small aneurysm over the subclavian artery (Picture A). The patient subsequently experienced a recurrent fever and was readmitted twice with MRSA bacteremia. CT studies disclosed a protruding aneurysm in the proximal subclavian artery (Picture B), and a diagnosis of a mycotic aneurysm was confirmed on serial CT images (1). Unfortunately, the patient died suddenly due to hypovolemic shock. This case illustrates that elderly patients undergoing hemodialysis are
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Division of Nephrology, Kaohsiung Veterans General Hospital, Taiwan, ２Department of Medicine, National Yang-Ming University School of Medicine, Taiwan and ３Department of Neurology, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Taiwan Received for publication June 18, 2014; Accepted for publication July 14, 2014 Correspondence to Dr. Chien-Liang Chen,
[email protected]
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Intern Med 54: 541-542, 2015
DOI: 10.2169/internalmedicine.54.3487
ideal targets for S. aureus mycotic aneurysm formation based on three characteristics: atherosclerosis, repeated puncture (2) and decreased immune defenses.
References
The authors state that they have no Conflict of Interest (COI).
1. Gonda RL Jr, Gutierrez OH, Azodo MVU. Mycotic aneuryms of the aorta: radiologic features. Radiology 168: 343-346, 1988. 2. Marr KA, Kong L, Fowler VG, et al. Incidence and outcome of Staphylococcus aureus bacteremia in hemodialysis patients. Kidney Int 54: 1684-1689, 1998.
Ⓒ 2015 The Japanese Society of Internal Medicine http://www.naika.or.jp/imonline/index.html
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