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Fulminant necrotising fasciitis by community-acquired methicillin-resistant Staphylococcus aureus
Journal article   Open access   Peer reviewed

Fulminant necrotising fasciitis by community-acquired methicillin-resistant Staphylococcus aureus

Lemuel Non and Aaron Kosmin
BMJ case reports, Vol.2015(mar30 1), pp.bcr2014206848-bcr2014206848
2015
DOI: 10.1136/bcr-2014-206848
PMCID: PMC4386447
PMID: 25824286
url
https://europepmc.org/articles/pmc4386447View
Published (Version of record) Open Access

Abstract

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a rare cause of necrotising fasciitis (NF), and is usually not fulminant as in group A Streptococcus (GAS), the archetypal aetiology. We report an unusually fulminant case of NF by CA-MRSA in an immunocompetent patient. A 52-year-old man presented to the emergency department with 1 week of progressive left thigh pain and swelling. The patient had ecchymoses, bullae and hypoesthesia of the involved skin, and CT scan revealed extensive fascial oedema. He was immediately started on broad spectrum antibiotics. Within 12 h of presentation, he underwent surgical debridement. Despite aggressive supportive care, the patient died less than 24 h after presentation. MRSA, with an antibiogram suggestive of a community-acquired strain, was recovered from intraoperative specimens and admission blood cultures. This case underscores that CA-MRSA, while rarely reported, can cause a fulminant presentation of NF similar to GAS in immunocompetent patients.

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