A 13-year-old male, with no history of hospitalization, previous use of antimicrobials, or contact with recently hospitalized people.
Located in the EU by increased volume and erythema in the elbow and left forearm, local pain and mild functional impotence of a week of evolution, secondary to multiple insect bites.
Physical examination revealed fever and hemodynamically stable malaise.
He had an erythematous volume increase of 6 x 5 cm, in relation to two crusted lesions in the left elbow.
The lesion was cleaned and purulent secretion was drained and cultured.
The tests showed a CRP of 8 mg/L and a normal blood count.
Ultrasound showed subcutaneous edema without deep involvement.
She was hospitalized for antimicrobial treatment with intravenous cloxacillin 100 mg/kg/day every 6 h.
During the first days of hospitalization, the patient developed pain, erythema and persistence of volume increase, always afflicted and without functional impotence.
The culture was positive for MRSA, so it was changed to intravenous clindamycin 30 mg/kg/day every 8 h.
The patient presented favorable evolution, with gradual reduction of pain, size of the lesion and erythema.
After completing seven days of clindamycin and regression of the lesions, she was discharged to complete oral antimicrobial treatment at home.
The isolated strain was studied in the ISP confirming MRSA and absence of PV-L marker.
Molecular characterization corresponded to the genetic subtype CL-SAU-COM-SMA003 (PFGE) and sequence ST8 by MLST.
A culture of intrafamilial nasal carriage was performed to detect S. aureus, all of which were negative.
