Methicillin-resistant Staphylococcus aureus enterocolitis sequentially complicated with septic arthritis: a case report and review of the literature

Abstract

BackgroundAlthough most reports describing patients infected with methicillin-resistant Staphylococcus aureus enterocolitis have been published in Japan, this concept remains a matter of debate and diagnostic criteria have not yet been defined.Case presentationThe general status of a 74-year-old Japanese man referred to our hospital (day 1) with severe community-acquired pneumococcal pneumonia gradually improved with antibiotic therapy. Thereafter, up to 4 L/day of acute watery diarrhea that started on day 19 was refractory to metronidazole but responded immediately to oral vancomycin. Gram staining stool samples was positive for abundant fecal leukocytes from which dominant methicillin-resistant Staphylococcus aureus (104 CFU/mL) were isolated, suggesting methicillin-resistant Staphylococcus aureus enterocolitis. High fever with methicillin-resistant Staphylococcus aureus bacteremia was evident at day 30, and suppurative right hip arthritis developed around day 71. All methicillin-resistant Staphylococcus aureus strains isolated from stools, blood and aspirated synovial fluid separated in the same manner on pulsed-field gel electrophoresis, as well as two other strains isolated from sputum, belonged to the same clone as sequence type (ST) 764 (complex clonal 5), and carried SCCmec type II.ConclusionThe clinical, microbiological and molecular biological findings of this patient indicated methicillin-resistant Staphylococcus aureus enterocolitis that led to septic methicillin-resistant Staphylococcus aureus arthritis.

Case of antibiotic-associated diarrhea caused by Staphylococcus aureus enterocolitis

“…7 A PubMed search through August 2014 using the terms enterocolitis and staphylococcus and enterocolitis and aureus produced 21 English-language case reports or case series involving adult patients ( Table 2). [8][9][10][11][12][13][14][15][16][17][18][19][20][21] Common among the cases reported in the literature was the presence of a large volume of green diarrhea. In some cases, as much as 4 L/day was reported.…”

Pseudomembranous colitis

“…S. aureus enterocolitis can present with pseudomembranes that can be loosely adherent and located in both the upper and lower GI tract. 153 This differs from pseudomembranes seen in CDI, which are tightly adherent, well-demarcated, and typically located only in the colon and ileocecal valve. 152 Pathology findings of S. aureus enterocolitis show pseudomembranes characterized by fibrin, necrotic areas with polymorphonuclear cells, and clusters of gram-positive cocci in the luminal border.…”

“…It is thought that 10% of colonized individuals will host S. aureus in the GI tract. 153 S. aureus enterocolitis is associated with prior use of antibiotics especially metronidazole and fluoroquinolones, immunosuppression, prior use of proton pump inhibitors, prior methicillin-resistant S. aureus (MRSA) colonization, and recent abdominal surgery. 154 Symptoms include fever, nausea, vomiting, inflammatory diarrhea, and abdominal pain.…”

Pseudomembranous colitis secondary tomethicillin-resistant Staphylococcus aureus(MRSA)

“…S. aureus enterocolitis can present with pseudomembranes that can be loosely adherent, and located in the upper and lower GI tract 9. This differs from pseudomembranes seen in C. difficile infection, which are tightly adherent, well demarcated and typically located only in the colon and ileocecal valve 1.…”