Nail dystrophy as initial presentation of systemic amyloidosisSystemic amyloidosis is a rare group of diseases that result from the extracellular deposition of amyloid protein. In patients with systemic amyloidosis, the most common skin symptoms are petechiae and ecchymoses; nail dystrophy as the initial symptom is rare, with only one previous report.A 50-year-old Chinese man developed bilateral fingernail and toenail lesions without apparent cause, manifested as thickening and destruction of nails followed by petechia developing under and around his fingernails, face and on both upper limbs (Fig. 1). After scratching, erythematous blisters appeared accompanied by swelling of the hands. There was no significant hair loss, sclerodermallike thickening, pigmentary changes or bullous lesions. He went to a nearby hospital and was diagnosed with contact dermatitis or eczema. After treatment, there was no significant improvement so he came to our hospital.No obvious abnormalities in myocardial enzyme, C3, C4, ANA, echocardiography, abdominal ultrasound and urological ultrasound. CT scan of the head also showed no Source(s) of support: None. Conflicting Interest: None.
Background
Community-associated Methicillin-resistant Staphylococcus aureus (CA-MRSA) is an emerging pathogen that leads to severe outcomes, especially in pediatric patients with multiple site infections.
Case presentation:
We report a case of a multiple organ and life-threatening infection caused by CA-MRSA in a 6-year-old girl who manifested sepsis, myelitis, purulent arthritis, purulent meningitis, hydropericardium, pneumonia, and empyema. The girl exhibited good response to the combination therapy of linezolid and rifampicin after treatment with vancomycin failed due to delay in achieving target serum concentration. We performed pleural effusion and hydropericardium effusion drainage and treated left lower limb infection using interdisciplinary approaches.
Conclusion
This case highlights the need to be aware of CA-MRSA infection, which requires accurate diagnosis, identification of site infection, appropriate antibiotic treatment, and surgical debridement.
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