title: From bone to heart: a case of MRSA osteomyelitis with haematogenous spread to the pericardium.
abstract: We report a case of a 55-year-old woman with a history of type 2 diabetes mellitus, Charcot arthropathy and end-stage renal disease, who presented with a syncopal episode after undergoing haemodialysis. She had a history of methicillin-resistant Staphylococcus aureus (MRSA) bacteraemia from an unknown source 3 months earlier, which was treated with an 8-week course of intravenous antibiotics. At the time of presentation to the emergency room, she was found to be in refractory shock. Bedside echocardiogram was performed, which showed moderate pericardial effusion. The effusion was later found to be due to MRSA, which was identified in blood and in pericardial fluid cultures. The patient was successfully treated with intravenous daptomycin for 6 weeks. Acute osteomyelitis of her right foot was the source of the MRSA, for which a right below-knee amputation was ultimately performed.
authors.affiliation: Department of Internal Medicine, Banner University Medical Center South, Tucson, Arizona, USA.
authors.forename: Parinita A
authors.initials: PA
authors.lastname: Dherange
authors.affiliation: Department of Internal Medicine, Banner University Medical Center South, Tucson, Arizona, USA.
authors.forename: Sarah
authors.initials: S
authors.lastname: Patel
authors.affiliation: Department of Cardiology, University of Arizona, Tucson, Arizona, USA.
authors.forename: Evbu
authors.initials: E
authors.lastname: Enakpene
authors.affiliation: Department of Cardiology, University of Arizona, Tucson, Arizona, USA.
authors.forename: Prakash
authors.initials: P
authors.lastname: Suryanarayana
mesh_terms: D000671:Amputation, Surgical; D000900:Anti-Bacterial Agents / Q000008:administration & dosage; D015897:Comorbidity; D005260:Female; D006801:Humans; D035002:Lower Extremity / Q000473:pathology / Q000601:surgery*; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D008875:Middle Aged; D010019:Osteomyelitis / Q000150:complications* / Q000382:microbiology; D010493:Pericarditis / Q000150:complications* / Q000382:microbiology; D010496:Pericardium / Q000382:microbiology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000382:microbiology; D013575:Syncope / Q000209:etiology* / Q000382:microbiology; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents