title: Fatal endocarditis with methicilin-sensible Staphylococcus aureus and major complications: rhabdomyolysis, pericarditis, and intracerebral hematoma: A case report and review of the literature.
abstract: BACKGROUND
  Over the last decades Staphylococcus aureus (SA) has become the dominant etiology of native valve infective endocarditis, with the community-acquired methicillin-sensible Staphylococcus aureus (CA-MSSA) strains being the prevailing type.
  
  
  METHODS
  We report here a case of extremely severe CA-MSSA aortic valve acute endocarditis associated with persistent Staphylococcus aureus bacteremia (SAB) in a previously healthy man and include a literature review.The patient developed severe and rare complications (purpura, purulent pericarditis, intracerebral hematoma, and rhabdomyolysis) through systemic embolism; they required drainage of pericardial empyema and cerebral hematoma, the latter eventually caused a fatal outcome. The strains recovered from sequential blood culture sets and pericardial fluid were MSSA negative for genes encoding for staphylococcal toxic shock syndrome toxin (TSST)-1 and Panton-Valentine leukocidin. C, G, and I enterotoxin genes were detected.
  
  
  CONCLUSIONS
  This case with unusually severe evolution underlines the limited ability of vancomycin to control some MSSA infections, possibly due to potential involvement of SA virulence factors, hence the importance of clinical vigilance for community SAB cases.
authors.affiliation: Department of Infectious Diseases Department of Anesthesiology and Intensive Care Department of Internal Medicine Department of Microbiology, University of Medicine and Pharmacy Tirgu Mures, Romania.
authors.forename: Anca Meda
authors.initials: AM
authors.lastname: Georgescu
authors.forename: Leonard
authors.initials: L
authors.lastname: Azamfirei
authors.forename: Krisztina
authors.initials: K
authors.lastname: Szalman
authors.forename: Edit
authors.initials: E
authors.lastname: Szekely
mesh_terms: D000328:Adult; D001706:Biopsy; D003937:Diagnosis, Differential; D004452:Echocardiography; D004562:Electrocardiography; D004696:Endocarditis / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology; D017809:Fatal Outcome; D046648:Hematoma, Subdural, Intracranial / Q000175:diagnosis / Q000209:etiology*; D006801:Humans; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus / Q000302:isolation & purification*; D010493:Pericarditis / Q000175:diagnosis / Q000209:etiology*; D012206:Rhabdomyolysis / Q000175:diagnosis / Q000209:etiology*; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000382:microbiology