SHM Converge Scientific Abstract ePoster Gallery-A Splinter's Spiral: an Unlikely Case of Metastatic Methicillin Sensitive Staph Aureus Bacteremia in a Young Immunocompetent Male

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This case report describes a previously healthy 34-year-old man who developed severe methicillin-sensitive Staphylococcus aureus (MSSA) bacteremia originating from left index finger cellulitis. He presented with progressive shortness of breath, chest pain, and worsening finger pain, erythema, and drainage. After admission for sepsis, he underwent incision and drainage with partial finger amputation; blood and wound cultures grew MSSA.<br /><br />Despite treatment, his illness rapidly complicated. By hospital day 2, he developed chest pain concerning for pericarditis, though transthoracic echocardiography showed no endocarditis. On day 3, he acutely worsened with fever, dyspnea, and chest pain. CT imaging revealed bilateral loculated pleural effusions and enlarging cavitary lung lesions, consistent with septic pulmonary emboli, even though repeat blood cultures were negative and transesophageal echocardiography still showed no endocarditis. Chest tubes were placed on day 4, draining exudative fluid; pleural fluid cultures and cytology were negative. He required ongoing drainage and received antibiotic therapy adjustments including cefepime, cefazolin, vancomycin, and linezolid. A MIST2 protocol was used to improve pleural drainage.<br /><br />Workup for immunocompromising conditions was unrevealing, and the surgical site remained controlled. Chest tube removal was complicated by pneumothorax on day 12, but he recovered and was discharged on day 15. Follow-up CT one week later showed improvement in cavitary lesions and pleural effusions, and he completed a one-month antibiotic course with cephalexin.<br /><br />The report highlights that MSSA bacteremia can cause serious metastatic complications even in immunocompetent patients without typical risk factors such as diabetes, dialysis, IV drug use, or autoimmune disease. Persistent fever beyond 72 hours and community-acquired infection are emphasized as warning signs for complicated bacteremia.

Asset Subtitle

Yasmeen A. Abdo

Meta Tag

Author List Ana Natale-Pereira, Brian Kim, Yasmeen A. Abdo

Category Clinical Vignettes

Concept MSSA Bacteremia

Concept Staphylococcus aureus Bacteremia

Concept Complicated Bacteremia

Concept Septic Pulmonary Emboli

Concept Blood Culture

Distinguished Non-Finalist

Presenter Organization Rutgers/NJMS

Presenting Author Yasmeen A. Abdo

Track Adult

Keywords

MSSA bacteremia

Staphylococcus aureus

cellulitis

sepsis

septic pulmonary emboli

cavitary lung lesions

pleural effusion

pericarditis

chest tube drainage

immunocompetent patient

MSSA Bacteremia

Staphylococcus aureus Bacteremia

Complicated Bacteremia

Septic Pulmonary Emboli

Blood Culture