Hi everyone,
I desperately needs thoughts or ideas about this case. Very long and complex, I'll try to simplify.
74-year-old male, reasonably healthy, the usual diabetes/cholesterol/blood pressure, history coronary stent 12 years ago. History diverticulitis, history kidney stones, history prostate cancer, latter treated by external irradiation. About a month ago patient started with what he thought was diverticulitis, with abdominal pain and night sweats, although pain in right lower abdomen, he started antibiotics that he had at home. No help, after a week he came in to see me, ordered CT of abdomen, showed large right ureteral stone. Stent was placed between kidney and bladder, after about five days lithotripsy done, after two weeks stent pulled. Patient never felt back to normal during this, he had been on antibiotics, but there was no definite urinary infection. The only positive urine culture was Candida.
Stent pulled, antibiotics stopped, but after five days felt much worse, high fevers, shaking chills. Three out of three blood cultures positive for Staph epi, methicillin-resistant, however according to sensitivities, these are two different strains. One bottle has one pattern of sensitivity, the other two bottles have different, but identical to each other sensitivities.
Extensive workup for infection otherwise negative, CT chest/abdomen/pelvis, repeat blood cultures, urine culture all negative. Transesophageal echocardiogram negative. Sed rate 130(!!!!). Preliminary Lyme negative.
Infectious disease consultant feels extremely strongly that staph epi is not a pathogen without some artificial nidus of infection (artificial joint, venous catheter, heart valve, etc.). He is convinced that the staph epi is all skin contaminant. He is actually favoring malignancy or connective tissue disorder, rather than infection.
Patient was on IV Vanco for about four days, seemed to get better, he's been off this for two days, seems to be getting worse.
Thoughts?
Thanks so much.
Gene
.png "ACUF Donor I")
