PMC7448131_01
(a) Electrocardiogram on arrival in the emergency room (ER) shows a narrow-complex rhythm with ST-segment depression in leads II, V4-V6. Sinus P-waves are seen in leads II, III, and aVF. (b) An electrocardiogram after the patient became unresponsive shows narrow-complex tachycardia with premature ventricular contraction and ST-segment depression in I, II, and V5, V6. No P-waves were identified.
10.1177_2050313X20952996-fig1.jpg
PMC7448131_01_10.1177_2050313X20952996-fig1.jpg
fig1-2050313X20952996
C-reactive protein (34.94 mg/dL (0.00-0.14 mg/dL)), increased procalcitonin (17.36 ng/mL (0.00-0.05 ng/mL)), leukocytosis (13,920 cells/mL (3300-8600 cells/mL)) with neutrophilia (92.9%), abnormalities on electrocardiography (narrow-complex rhythm with ST-segment depression in leads II and V4-V6 (Figure 1(a)) changing to narrow-complex tachycardia with premature ventricular contraction and ST-segment depression in leads I, II, V5, and V6 (Figure 1(b)), and metabolic alkalosis with respiratory compensation (pH, 7.417; partial pressure of carbon dioxide (PCO2), 40.5 mmHg; partial pressure of oxygen (PO2), 80.0 mmHg; bicarbonate (HCO3-), 25.5 mmol/L; base excess, 0.9 mmol/L; and lactate, 1.93 mmol/L). Computed tomography (CT) showed multiple low-density areas, and contrast-enhanced CT showed disseminated abscess in the left axilla, right hip, and right leg (Figure 2(a) and (b)).
(a) Contrast-enhanced computed tomography (CT) shows a capsule-enclosed abscess in the left axilla (arrow). (b) Contrast-enhanced CT shows two capsule-enclosed abscesses in the right leg (arrows).
10.1177_2050313X20952996-fig2.jpg
PMC7448131_01_10.1177_2050313X20952996-fig2.jpg
fig2-2050313X20952996
C-reactive protein (34.94 mg/dL (0.00-0.14 mg/dL)), increased procalcitonin (17.36 ng/mL (0.00-0.05 ng/mL)), leukocytosis (13,920 cells/mL (3300-8600 cells/mL)) with neutrophilia (92.9%), abnormalities on electrocardiography (narrow-complex rhythm with ST-segment depression in leads II and V4-V6 (Figure 1(a)) changing to narrow-complex tachycardia with premature ventricular contraction and ST-segment depression in leads I, II, V5, and V6 (Figure 1(b)), and metabolic alkalosis with respiratory compensation (pH, 7.417; partial pressure of carbon dioxide (PCO2), 40.5 mmHg; partial pressure of oxygen (PO2), 80.0 mmHg; bicarbonate (HCO3-), 25.5 mmol/L; base excess, 0.9 mmol/L; and lactate, 1.93 mmol/L). Computed tomography (CT) showed multiple low-density areas, and contrast-enhanced CT showed disseminated abscess in the left axilla, right hip, and right leg (Figure 2(a) and (b)).
(a, b) Diffusion-weighted magnetic resonance imaging (MRI) reveals focally increased signal intensity in the left cerebellar hemisphere and right superior corona radiata (arrow), with septic emboli associated with methicillin-resistant S. aureus (MRSA) bacteremia difficult to distinguish from emboli due to atrial fibrillation. (c) Sagittal short tau inversion recovery (STIR)-weighted MRI shows focally increased signal intensity in the intervertebral disc between the L2 and L3 lumbar spines (arrow). (d) Coronal T2-weighted spectral attenuated inversion recovery (SPAIR) MRI shows bilateral iliopsoas muscle abscesses (arrows).
10.1177_2050313X20952996-fig3.jpg
PMC7448131_01_10.1177_2050313X20952996-fig3.jpg
fig3-2050313X20952996
Magnetic resonance imaging (MRI) of the brain showed multiple septic emboli (Figure 3(a) and (b)), and MRI of the lumbar spine showed infectious spondylodiscitis and iliopsoas abscess (Figure 3(c) and (d)).