1. MRSA septic pulmonary emboli presenting as isolated focal chest pain in an adolescent
- Author
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Robert N. Husson, Danielle G. Rabinowitz, Stephen M. Chrzanowski, Jeffrey I. Campbell, Carolyn H. Marcus, Alicia Casey, and Jaclyn Davis
- Subjects
lcsh:Medical physics. Medical radiology. Nuclear medicine ,medicine.medical_specialty ,medicine.drug_class ,lcsh:R895-920 ,Antibiotics ,HS, hidradenitis suppurativa ,Case Report ,Chest pain ,medicine.disease_cause ,030218 nuclear medicine & medical imaging ,Pediatric radiology ,Lesion ,SPE, septic pulmonary embolism ,03 medical and health sciences ,0302 clinical medicine ,Biopsy ,medicine ,Radiology, Nuclear Medicine and imaging ,Doxycycline ,medicine.diagnostic_test ,business.industry ,DVT, deep vein thrombosis ,CT-PA, computed tomography-pulmonary angiography ,MRSA, methicillin-resistant Staphylococcus aureus ,Methicillin-resistant Staphylococcus aureus ,Pediatric Radiology ,Superinfection ,CRP, C-reactive protein ,Septic pulmonary embolism ,Methicillin-resistant staphylococcus aureus ,ED, emergency department ,Radiology ,medicine.symptom ,business ,030217 neurology & neurosurgery ,medicine.drug - Abstract
This case demonstrates the importance of considering septic pulmonary embolism (SPE) on the differential for chest pain in the pediatric population, especially in patients with a history of skin and soft tissue infection. The adolescent patient in this report, with a history of axillary hidradenitis suppurativa complicated by methicillin-resistant Staphylococcus aureus (MRSA) superinfection and recent completion of a 3-month course of doxycycline, presented with isolated focal chest pain in the absence of other infectious or respiratory signs or symptoms. Initial pulmonary imaging revealed multiple bilateral wedge-shaped nodules. Three specialty teams were consulted in the patient's evaluation, resulting in biopsy of a suspicious lesion that confirmed the diagnosis of MRSA SPE. Following a course of targeted antibiotic therapy, the patient's chest pain resolved and imaging findings improved. Insights gleaned from the workup of this patient are useful in formulating a framework for recognition of SPE in children presenting with chest pain, and also highlight the importance of considering insidious SPE presentation in the setting of antibiotic pretreatment.
- Published
- 2020