1. The patient is a 30-year old nursing student who was exposed 3 weeks prior to
ID: 3524700 • Letter: 1
Question
1. The patient is a 30-year old nursing student who was exposed 3 weeks prior to admission to his daughter who had chicken pox. Eight days prior to admission, he developed a vesicular-pustular rash of fluid-filled lesions on his upper trunk and face which over the next week opened, crusted over, and began to heal. Because he continued to have fevers and abdominal pain, he was given oral acyclovir 4 days prior to admission. His family reported that a vesicle on his right buttock became enlarged and red at this time, and they treated it with hydrocortisone cream (although this reduces swelling it acts as a localized immunosuppresant). One day before presentation he developed vomiting, shortness of breath, and pain, redness and swelling of his left leg. He was admitted to the local hospital, and treatment with ciprofloxacin (a quinolone) and gentamicin (an aminoglycoside) was begun. Shortly after his systolic blood pressure dropped to 60 mm Hg, and he became unresponsive. He was intubated and transferred to a regional hospital.
A) What pathogen caused his rash? Why is this unusual?
Lab tests run on pus from the lesion on his buttock indicated a gram positive staphylococcus that could grow on Mannitol Salt Agar and produced yellow colonies. However, while running the lab tests, the patient dies of systemic shock and organ failure.
B) Diagnose the disease that killed him and describe the pathogenic agent.
Explanation / Answer
A. The rash is caused by herpes simplex virus. This virus usually infects after having a round of chicken pox infection. this is usually treated using acyclovir. The use of hydrocortisone aggrevated the disease due to the immunosuppression.
B. The disease that killed is due to extensive bacterial infection by Staphylococcus which is an opportunistic bacteria and grows on anything in the body. Due to high bacterial infection, the body wen into a shock which is called septic shock leading to multiple organ failure.
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