title: Methicillin-resistant Staphylococcus aureus enterocolitis sequentially complicated with septic arthritis: a case report and review of the literature.
abstract: BACKGROUND
  Although most reports describing patients infected with methicillin-resistant Staphylococcus aureus enterocolitis have been published in Japan, this concept remains a matter of debate and diagnostic criteria have not yet been defined.
  
  
  METHODS
  The general status of a 74-year-old Japanese man referred to our hospital (day 1) with severe community-acquired pneumococcal pneumonia gradually improved with antibiotic therapy. Thereafter, up to 4 L/day of acute watery diarrhea that started on day 19 was refractory to metronidazole but responded immediately to oral vancomycin. Gram staining stool samples was positive for abundant fecal leukocytes from which dominant methicillin-resistant Staphylococcus aureus (10(4) CFU/mL) were isolated, suggesting methicillin-resistant Staphylococcus aureus enterocolitis. High fever with methicillin-resistant Staphylococcus aureus bacteremia was evident at day 30, and suppurative right hip arthritis developed around day 71. All methicillin-resistant Staphylococcus aureus strains isolated from stools, blood and aspirated synovial fluid separated in the same manner on pulsed-field gel electrophoresis, as well as two other strains isolated from sputum, belonged to the same clone as sequence type (ST) 764 (complex clonal 5), and carried SCCmec type II.
  
  
  CONCLUSIONS
  The clinical, microbiological and molecular biological findings of this patient indicated methicillin-resistant Staphylococcus aureus enterocolitis that led to septic methicillin-resistant Staphylococcus aureus arthritis.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Ogawa
authors.affiliation: Department of Respiratory Medicine, Kyorin University School of Medicine, 6-20-2 Shinkawa, Mitaka, Tokyo 181-8611, Japan. sara@yd5.so-net.ne.jp.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Saraya
authors.forename: Takashi
authors.initials: T
authors.lastname: Koide
authors.forename: Ken
authors.initials: K
authors.lastname: Kikuchi
authors.forename: Kosuke
authors.initials: K
authors.lastname: Ohkuma
authors.forename: Koji
authors.initials: K
authors.lastname: Araki
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Makino
authors.forename: Shota
authors.initials: S
authors.lastname: Yonetani
authors.forename: Hajime
authors.initials: H
authors.lastname: Takizawa
authors.forename: Hajime
authors.initials: H
authors.lastname: Goto
mesh_terms: D000368:Aged; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D001170:Arthritis, Infectious / Q000209:etiology / Q000382:microbiology*; D016470:Bacteremia / Q000382:microbiology; D015373:Bacterial Typing Techniques; D055499:Catheter-Related Infections / Q000382:microbiology; D057785:Catheters / Q000382:microbiology; D002999:Clone Cells; D017714:Community-Acquired Infections / Q000150:complications / Q000188:drug therapy; D003428:Cross Infection / Q000150:complications / Q000382:microbiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications; D003937:Diagnosis, Differential; D004198:Disease Susceptibility; D004760:Enterocolitis / Q000150:complications / Q000175:diagnosis / Q000382:microbiology*; D004761:Enterocolitis, Pseudomembranous / Q000175:diagnosis; D004866:Equipment Contamination; D019143:Evolution, Molecular; D005243:Feces / Q000382:microbiology; D006621:Hip Joint / Q000382:microbiology*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000145:classification / Q000235:genetics / Q000302:isolation & purification*; D011018:Pneumonia, Pneumococcal / Q000150:complications / Q000188:drug therapy; D012772:Shock, Septic / Q000175:diagnosis; D013203:Staphylococcal Infections / Q000150:complications / Q000382:microbiology*; D013582:Synovial Fluid / Q000382:microbiology; D014640:Vancomycin / Q000627:therapeutic use
chemical_list: D000900:Anti-Bacterial Agents; D014640:Vancomycin