title: A case of severe staphylococcal septicaemia: septic arthritis and a mediastinal abscess following leflunamide therapy for rheumatoid arthritis.
abstract: This highly unusual case illustrates how a potentially life-threatening complication may develop insidiously in the context of immunosuppression. A 46-year-old woman presented with increasing malaise and a marked inflammatory response in the context of immunosuppressive therapy for rhueumatoid arthritis. On the basis of microbiological findings, the patient was treated for systemic staphylococcal infection with a prolonged antibiotic course. In addition, incision and drainage procedures were performed on associated, non-resolving abscesses at various sites. One particular lesion in the breast was slow to heal and was monitored with ultrasound imaging. Subsequent cross-sectional imaging revealed that this was, in fact, a large mediastinal abscess, eroding the manubrium and lying within close proximity of the aorta. The patient was eventually referred to a cardiothoracic unit for complete evacuation of this lesion. Following a prolonged illness and treatment period, the patient recovered well and successfully resumed employment.
authors: Lister Hospital, Stevenage, Hertfordshire, UK. ABala75@hotmail.com
authors: Anjali
authors: A
authors: Balasanthiran
authors: Tannaz
authors: T
authors: Vakilgilani
authors: Ken
authors: K
authors: Darzy
authors: Jeremy
authors: J
authors: Axon
mesh_terms: D000038:Abscess / Q000209:etiology* / Q000276:immunology / Q000628:therapy*; D000305:Adrenal Cortex Hormones / Q000627:therapeutic use; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D001172:Arthritis, Rheumatoid / Q000175:diagnosis / Q000188:drug therapy; D016470:Bacteremia / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D004322:Drainage / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016867:Immunocompromised Host; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use; D007555:Isoxazoles / Q000009:adverse effects* / Q000627:therapeutic use; D000077339:Leflunomide; D008875:Middle Aged; D018570:Risk Assessment; D012720:Severity of Illness Index; D013290:Streptococcal Infections / Q000188:drug therapy / Q000209:etiology* / Q000276:immunology; D016896:Treatment Outcome
chemical_list: D000305:Adrenal Cortex Hormones; D000900:Anti-Bacterial Agents; D007166:Immunosuppressive Agents; D007555:Isoxazoles; D000077339:Leflunomide