title: Epidermolysis bullosa acquisita of MRSA skin carrier: a case of successful total hip arthroplasty.
abstract: OBJECTIVE
  Epidermolysis bullosa acquisita (EBA) is a very rare disease of a chronic autoimmune subepidermal blistering, usually manifesting as skin fragility, blisters and erosions. In this article, we report a successful THA in a patient with osteonecrosis of the femoral head with EBA and methicillin-resistant staphylococcus aureus (MRSA) skin carriage.
  
  
  METHODS
  A 59-year-old woman had severe and debilitating left hip pain due to osteonecrosis of the femoral head. She had suffered from EBA for the past 7 years. She had received several courses of intravenous steroid pulse therapy in the past, and taking 6 mg of prednisone and 100 mg of minocycline per day for infected skin blisters. Severe blisters and scars covered her body, especially at the prone area. A bacteriological examination taken using a cotton-swab returned MRSA at the nasal cavity and anterolateral part of the proximal femur.
  
  
  RESULTS
  We employed an antibiotic prophylactic protocol used for one-stage revision for infected hip prosthesis. Primary THA was performed using the anterior approach with antibiotic-loaded cement, and the skin was fully covered with a soft and conformable foam dressing.1-year post-op, there are no signs of infection. The Harris Hip Score improved from 37 pre-op to 93.4 at 1 year post-op.
  
  
  CONCLUSIONS
  Although care must be taken by medical professionals to avoid the prescription of unnecessary antibiotics, when used appropriately, there appears to be substantial benefits to be gained in the field of joint replacement for patients who are at high risk of infection.
authors.affiliation: 1 Department of Orthopaedic Surgery, Juntendo University, Tokyo - Japan.
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Homma
authors.forename: Tomonori
authors.initials: T
authors.lastname: Baba
authors.forename: Kenji
authors.initials: K
authors.lastname: Goto
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maruyama
authors.forename: Kazuo
authors.initials: K
authors.lastname: Kaneko
mesh_terms: D019644:Arthroplasty, Replacement, Hip / Q000379:methods*; D016107:Epidermolysis Bullosa Acquisita / Q000150:complications* / Q000382:microbiology; D005260:Female; D005271:Femur Head Necrosis / Q000150:complications / Q000601:surgery*; D006801:Humans; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D012867:Skin / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology