Intercostal Muscle Abscesses in Infective Endocarditis Associated With Migratory Deposition of Calcium Pyrophosphate

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This case report describes an 86-year-old female patient who presented with complex post-surgical complications following orthopedic surgery for a femoral neck fracture. Initially diagnosed with septic shock due to methicillin-resistant Staphylococcus aureus (MRSA) bacteremia at the surgical site, the patient's treatment course was complicated, involving multiple hospital transfers and varying treatments, including antibiotics and surgical drainage. Despite the absence of infection indicators post treatment, the patient later developed severe thigh pain and was found to have migratory pseudogout, an unusual diagnosis in the context of MRSA and post-surgical complications. This report emphasizes the diagnostic challenges in distinguishing between surgical site infections and other inflammatory conditions like migratory pseudogout, particularly in older patients with comorbidities. It underscores the importance of comprehensive evaluations and the need for general physicians to maintain a broad differential diagnosis when managing post-surgical infections. The case highlights the persistence and recurrence risk of MRSA infections, even post-appropriate antibiotic therapy, and the necessity of considering migratory pseudogout in patients with recurrent infections and systemic soft tissue involvement. The insights from this case contribute to the understanding of complex post-surgical complications and advocate for meticulous assessment and tailored treatment strategies in similar clinical scenarios.

Section: Introductionmentioning

confidence: 66%

Migratory Deposition of Calcium Pyrophosphate in an Older Patient With Several Femoral Neck Implant Infection Episodes: A Case Report

Ohta,

Shigetaka,

Sano

2023

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“…Causative organism was Pasteurella multocida [7]. Another case of IE with intercoastal muscle abscess caused by Staphylococcus aureus was reported by Nakayama et al [8].…”

Section: Discussionmentioning

confidence: 88%

Infective Endocarditis Presenting as Rhabdomyolysis and Muscle Abscess: A Case Report

Ambra,

Palol,

Moidy

et al. 2023

Rhabdomyolysis is characterized by the degradation of skeletal muscle tissue, which releases cellular contents into circulation. This condition commonly stems from various factors, including trauma, overexertion, muscular hypoxia, infections, metabolic and electrolyte imbalances, certain medications, toxins, and genetic abnormalities. Despite this, instances of rhabdomyolysis precipitated by bacteremia of infective endocarditis remain exceedingly rare. This report describes an unusual case wherein infective endocarditis manifested as rhabdomyolysis, accompanied by a muscular abscess and acute renal failure. The patient's condition was successfully managed through hydration and targeted antibiotic therapy, leading to a favorable recovery. The case underscores the importance of vigilance for extracardiac symptoms and signs of infective endocarditis, such as rhabdomyolysis and muscular abscesses. Of particular note in this case was the discovery of an atypical causal bacterium, Streptococcus dysgalactiae, in the setting of infective endocarditis. This case highlights the broad range of potential manifestations and causal factors associated with this serious cardiac condition.

“…Some publications report the formation of superficial muscle abscesses due to Staphylococcus aureus bacteremia. In muscles near joints, there are also reports that deposition of calcium pyrophosphate crystals, as observed in pseudogout, may result in pseudo abscess formation and increased susceptibility to infection [ 10 ]. It should also be recognized that S. aureus is the primary causative organism of infective endocarditis and that a wide range of clinical manifestations and musculoskeletal complaints of infective endocarditis are relatively common, with reports of initial manifestation of musculoskeletal symptoms that may present as pseudogout-like symptoms [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

Pseudogout as a Cause of Fever of Unknown Origin Following Staphylococcal Bacteremia in an Older Patient

Yamauchi¹,

Ohta²,

Igarashi³

et al. 2022

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The causes of fevers in older adults are numerous and diverse, resulting in fevers of unknown origin that complicate the diagnosis process. Compared to young adults, older adults are characterized by comorbidities, aging-induced physiological changes, decreased homeostasis, reduced activities of daily living, and a diminished quality of life due to disease and aging. Thus, diverse perspectives are required to facilitate the accurate diagnosis of fever in older adults. In this study, we experienced a case of epidermal staphylococcal bacteremia of unknown cause with a persistent fever that eventually led to the diagnosis of cervical pseudogout. A 94-year-old bedridden woman visited our hospital with a chief complaint of persistent fever. She was diagnosed with cervical pseudogout after closely examining the prolonged fever following Staphylococcus epidermidis bacteremia. Noninfectious diseases are frequent causes of unexplained fever in older adults, and systemic inflammatory diseases, such as cervical pseudogout, should be considered during examination.