PMC8178119_01
Clinical, microbiologic, radiographic, and histopathologic findings in a case of MRSA enterocolitis. (A) Timeline of the clinical course from diagnosis to death. (B) Stool cultures from a healthy individual (left) and from the patient (right) showing yellow colonies surrounded by hemolysis. (C) Antibiotic susceptibility testing of the Staphylococcus aureus isolate. (D) CT scan of the abdomen with the yellow arrow indicating an area of pneumatosis. (E) Postmortem histopathology of small bowel mucosa. The black arrow points to an area of Gram-positive cocci. The dotted arrow points to an area of submucosal necrosis and hemorrhage. Abbreviations: IV, intravenous; PO, oral; Vanc, vancomycin; Pip/tazo, piperacillin/tazobactam; MIC, minimum inhibitory concentration; AML, acute myeloid leukemia; CT, computed tomography; GCLAM, filgrastim, cladribine, cytarabine, and mitoxantrone; MIC, minimum inhibitory concentration; MRSA, methicillin resistant Staphylococcus aureus; TLS, tumor lysis syndrome.
gr1.jpg
PMC8178119_01_gr1.jpg
fig0001
A 72-year-old man with a history of clinically quiescent Crohn's disease presented to the emergency department with fever, fatigue, altered mental status, and nausea/vomiting four days after a new diagnosis of acute myelogenous leukemia (AML) (Fig. 1A). Two days later, the blood agar plate showed 4+ MRSA with reduced normal fecal flora (Fig. 1B and C). CT of the abdomen and pelvis showed diffuse small bowel wall edema, thickening, dilatation measuring up to 6.2 cm, and pneumatosis without pneumoperitoneum (Fig. 1D). Postmortem evaluation revealed gross dilatation of the duodenum and jejunum with dusky discoloration, mucosal erythema and congestion, and Gram positive cocci (Fig. 1E).