A case of multiple staphylococcic abscesses and empyema in a young adult

A 24 years old male patient who presented with fever, cough, weight loss, pain in the right shoulder and chest as well as swelling with severe pain in the right thigh, has been hospitalized in our clinic. These symptoms were present since one month and with no response to wide spectrum antibiotics administered under non-hospitalized conditions. Cachexia, inadequate oral hygiene and limitations of movements were also observed. Non respiratory sounds could be heard on the right with auscultation and there was extensive dullness. A fluctu¬ating hot abscess of approximately 10X10 cm diameter was detected on the right thigh. 12 600/mm3 of leucocytes, a shift to the left in the formula, normocytic anemia were also noted. In his chest X-ray, diffuse homogenius density at the right and at the thorax CT, locular, encysted pleural effusion was detected. At CT sections obtained from femoral level, two collections of abscess were observed on the right. Pleural and abscess fluid cultures were Stafilococcus aureus positive. Immune deficiency that was also observed clinically was confirmed by lymphocytes subpopulation analysis. Cefasolin at 2 g/day doses has been administered for I month for treatment. As the patient was not belonging to the child, or elderly population and he did not presented with nasocomial infection characteristics, it was considered as a staphylococcic infection case with a course of multilocular abscesses and encysted pleural empyema as a result of a possible sepsis due to staphylococci of the mouth flora.

Genç eriþkin hastada multipl stafilokoksik abse ve ampiyem

Ateþ, öksürük, zayýflama, sað omuz ve göðüs aðrýsý, sað uylukta.þiddetli aðrýlý þiþlik þikayetleri ile kliniðimize interne edilen 24 yaþýndaki erkek hastanýn anamnezinden, semptomlarýn bir ay süreli olduðu ve ayaktan uygulanmýþ olan geniþ spektrumlu antibiyotiklere cevap vermediði öðrenildi. Kaþeksi (boy 163 cm., kilo 43 kg) aðýz hijyeni bozukluðu, hareket kýsýtlýlýðý gözlendi. Saðda oskültasyonla solunum sesleri duyulmuyordu ve yaygýn matite mevcuttu. Sað uylukta yaklaþýk 10x10 cm. çapýnda fluktuasyon veren sýcak abse saptandý. Lökosit 126001mm3 idi. Formülde sola kayma, normokrom normositik anemi saptandý. PA akciðer graf isinde saðda total, yer yer homojen opak dansite artýþlarý ile bilgisayarlý tomografide loküle ankiste plevral efiizyon saptandý. Femoral düzeyden alýnan BT kesitlerinde saðda collum femoralis düzeyinde 3.5x5.5x12 cm. çapýnda ve ileopsoas kasýnda 3 cm.’lik iki adet abse koleksiyonu gözlendi. Plevral sývý ve abse kültürlerinde Staphylococcus auýeýýs üredi. Klinik olarak gözlenen imnün yetersizliði ayrýca kanda lenfosit subpopulasyon incelemesi ile kanýtlandý. Tedavide bir ay süre ile sefazolin sodyum 2g/gün dozunda uygulandý. Subplevral kapalý tüp tora kostomi ile‘toplam 4000 mi. sývý 25 günde aspire edildi. Hastanýn çocuk veya ileri yaþ grubunda olmamasý, nozokomiyal infeksiyon niteliði göstermemesi nedenleriyle genç eriþkinde %I0 gibi düþük bir sýklýkla aðýz florasýndan stafilokoklara baðlý olasý bir sepsis sonucu multilokule aliseler ve ankiste plevral ampiyemle seyreden stafilokok in.feksi.yonu tablosu. olarak deðerlendirildi.