title: Fulminant necrotising fasciitis by community-acquired methicillin-resistant Staphylococcus aureus.
abstract: Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a rare cause of necrotising fasciitis (NF), and is usually not fulminant as in group A Streptococcus (GAS), the archetypal aetiology. We report an unusually fulminant case of NF by CA-MRSA in an immunocompetent patient. A 52-year-old man presented to the emergency department with 1 week of progressive left thigh pain and swelling. The patient had ecchymoses, bullae and hypoesthesia of the involved skin, and CT scan revealed extensive fascial oedema. He was immediately started on broad spectrum antibiotics. Within 12 h of presentation, he underwent surgical debridement. Despite aggressive supportive care, the patient died less than 24 h after presentation. MRSA, with an antibiogram suggestive of a community-acquired strain, was recovered from intraoperative specimens and admission blood cultures. This case underscores that CA-MRSA, while rarely reported, can cause a fulminant presentation of NF similar to GAS in immunocompetent patients.
authors.affiliation: Department of Medicine, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Lemuel
authors.initials: L
authors.lastname: Non
authors.affiliation: Department of Infectious Diseases, Albert Einstein Medical Center, Philadelphia, Pennsylvania, USA.
authors.forename: Aaron
authors.initials: A
authors.lastname: Kosmin
mesh_terms: D000900:Anti-Bacterial Agents / Q000008:administration & dosage*; D016470:Bacteremia / Q000175:diagnosis / Q000382:microbiology*; D017714:Community-Acquired Infections / Q000175:diagnosis / Q000382:microbiology; D003646:Debridement; D019115:Fasciitis, Necrotizing / Q000175:diagnosis* / Q000382:microbiology*; D017809:Fatal Outcome; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D013203:Staphylococcal Infections / Q000175:diagnosis* / Q000382:microbiology / Q000473:pathology; D013848:Thigh / Q000382:microbiology / Q000473:pathology*
chemical_list: D000900:Anti-Bacterial Agents
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