Two cases of <i>Staphylococcus aureus</i> bacteremia causing atypical disseminated infection in patients undergoing hemodialysis

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  • Kawasaki So
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Watanabe Shuhei
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Fujisawa Yuka
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Hirai Toshiyuki
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Kanai Daisuke
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Saigan Madoka
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Kumamoto Nobuyuki
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Hara Akiko
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Takiguchi Rie
    Department of Nephrology, Kobe City Medical Center West Hospital
  • Nishi Shinichi
    Division of Nephrology and Kidney Center, Kobe University Graduate School of Medicine

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Other Title
  • 黄色ブドウ球菌菌血症から非典型的な部位に播種性感染を認めた血液透析患者の2症例
  • オウショクブドウキュウキン キンケツショウ カラ ヒテンケイテキ ナ ブイ ニ ハシュ セイカンゾメ オ ミトメタ ケツエキ トウセキ カンジャ ノ 2 ショウレイ

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Abstract

<p>Case 1：A 58-year-old woman who has been undergoing hemodialysis for eight years was admitted to our hospital for fever and right shoulder pain. Computed tomography (CT) showed right sternoclavicular joint arthritis, and clavicular abscess and blood culture tests revealed methicillin-sensitive Staphylococcus aureus. Despite the initiation of antibiotics, the shoulder pain worsened. On day 37, right clavicular osteomyelitis was identified by magnetic resonance imaging. On day 66, the patient was transferred to another hospital for surgical treatment. Case 2：An 83-year-old man who has been undergoing hemodialysis for six years. The infection of an arteriovenous fistula (AVF) with methicillin-resistant Staphylococcus aureus (MRSA) bacteremia was initially treated by antibiotics, and then AVF removal surgery was performed three months previously. The symptoms improved and blood cultures became negative. After two weeks, a blood laboratory test showed elevated C-reactive protein and a blood culture test was again positive for MRSA. Contrast-enhanced CT showed a mediastinal abscess. Regardless of the administration of mediastinal drainage and antibiotics, the patient died on day 17. Concerning Staphylococcus aureus bacteremia in patients undergoing hemodialysis, we should maintain vigilance for atypical disseminated infections.</p>

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