title: Bilateral thigh methicillin-resistant Staphylococcus aureus necrotising fasciitis in a man with newly diagnosed Human Immunodeficiency Virus (HIV).
abstract: Methicillin-resistant Staphylococcus aureus (MRSA) necrotising fasciitis (NF) is rare and constitutes a medical and surgical emergency. We report a case of a 53-year-old man with type-2 diabetes mellitus and newly diagnosed HIV infection who presented with 1 week of progressively worsening bilateral sharp thigh pain. On presentation, he was febrile, tachycardic and had bilateral thigh erythema and mild tenderness without open wounds. He had leucocytosis, lactic acidosis and acute kidney injury. Urgent incision and drainage (I&D) was performed for suspected NF. Blood cultures and I&D were positive for MRSA. Biopsy of bilateral thighs showed NF. He was treated with wound washout and 6 weeks of intravenous antibiotics. After undergoing skin graft for wounds, he was discharged to physical rehabilitation. Here we report severe sepsis from bilateral thigh MRSA NF in a patient with newly diagnosed HIV.
authors.affiliation: University of Louisville, Louisville, Kentucky, USA.
authors.forename: Dhruv
authors.initials: D
authors.lastname: Chaudhary
authors.affiliation: University of Louisville, Louisville, Kentucky, USA.
authors.forename: Amith
authors.initials: A
authors.lastname: Subhash
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Galvis
authors.affiliation: Department of Pulmonary, Critical Care, and Sleep Disorders Medicine, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors.forename: Juan
authors.initials: J
authors.lastname: Guardiola
mesh_terms: D061605:Administration, Intravenous; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D023241:Antiretroviral Therapy, Highly Active; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D004322:Drainage; D019115:Fasciitis, Necrotizing / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D015658:HIV Infections / Q000150:complications* / Q000188:drug therapy; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D055624:Methicillin-Resistant Staphylococcus aureus; D008875:Middle Aged; D018805:Sepsis / Q000150:complications* / Q000628:therapy; D013203:Staphylococcal Infections / Q000150:complications* / Q000175:diagnosis / Q000473:pathology / Q000628:therapy; D007507:Therapeutic Irrigation; D013848:Thigh
chemical_list: D000900:Anti-Bacterial Agents