abscesses, and severe necrotizing pneumonia. 1 Gillet et al. pointed out that PVL-positive strains of S. aureus cause rapid progressive severe necrotic pneumonia in otherwise healthy children and young adults. 2 We report an immunocompromised patient with tendon destruction associated with PVLpositive S. aureus infection.A 62-year-old woman with Sézary syndrome, a leukaemic variant of cutaneous T-cell lymphoma, had received oral prednisolone 10 mg daily for 2 years. She also suffered from diabetes and recurrent bacterial skin infections. She developed a painful abscess on the dorsum of her right hand associated with a low-grade fever (Fig. 1). Laboratory investigations showed a white blood cell count of 22AE4 · 10 9 L )1 with 51% neutrophils, 4% lymphocytes, 2AE5% monocytes and 41% atypical lymphocytes. C-reactive protein was 2AE1 mg dL )1 . No radiological signs of osteomyelitis were noted. Bacterial cultures from the abscess yielded methicillin-resistant S. aureus. Polymerase chain reaction amplification detected the PVL gene from the strain, and the nucleotide sequence of PVL was confirmed by direct sequencing. Enterotoxins and toxic shock syndrome toxin-1 were not detected in the supernantants. Blood cultures were negative. She was treated with surgical drainage and a combination of fosfomycin, albekacin sulphate and ampicillin sodium ⁄sulbactam sodium. Although the abscess slowly improved, an extension disturbance of the finger appeared due to destruction of the tendons of the extensor digitorum muscle a few days later, and this did not improve.Although hand infections in diabetic patients result in more deep-space infections, osteomyelitis, tenosynovitis, deformity and permanent disability than in nondiabetic patients, 3 subcutaneous abscesses rarely causes tendon damage. Our case suggests that PVL may cause tendon destruction when PVL-producing S. aureus infects immunocompromised hosts.
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