A 39 year old woman comes into the ER with swelling and redness of her right leg
ID: 3520707 • Letter: A
Question
A 39 year old woman comes into the ER with swelling and redness of her right leg. She had fallen while rollerblading and had a number of abrasions on the skin of her leg. She has a body temperature of 37.8*C (100* F). The ED physician orders a culture of her leg wound, gave her a prescription for the antibiotics, and discharged her from treatment.
The following evening, the patient collapsed onto the floor of her bedroom. Her roommate found her and called 911. On arrival, the paramedics found an unconscious female with blood pressure of 80/40 mm Hg and pronounced redness and swelling of her right leg. She was rushed to the ED and admitted to the ICU, where she was immediately placed on IV fluids and medications to raise her blood pressure.
What caused her sudden hypotension?
What is the probable organism for the swelling and redness of her right leg? Explain your answer.
If testing was performed on the patient initially, what would have been found? (Not cultures).
What other symptoms may have been seen with this case?
Explanation / Answer
The patient collapsed, mean hypotension following one day of infection. There was fever, bruises over the skin of the leg. All these conditions indicate that the infective pathogen entered the bloodstream via the skin wound. But there is no mention of mud or any other contamination of those wounds--> these prove that the patient is suffering from toxic syndrome due to Staphylococcus infection, which is a normal commensal of the skin.
So toxic shock syndrome caused the hypotension [ due to the release of toxins from Staphylococcus aureus ].
If the swab was collected from the wounds, gram stained and observed under light microscope---> staphylococcus could be seen as clusters of grapes. This bacteria is catalase positive, so a catalase test could detect the staphylococcus.
Other symptoms:
Vomiting, diarrhea.
Rashes.
Redness of eyes,
Muscle ache.
Seizures.
A headache
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