Chen Y, Chen D, Liu H, Zhang CG, Song LL. Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis: A case report. World J Clin Cases 2022; 10(36): 13418-13425 [PMID: 36683620 DOI: 10.12998/wjcc.v10.i36.13418]
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
World J Clin Cases. Dec 26, 2022; 10(36): 13418-13425 Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13418
Staphylococcus aureus bacteremia and infective endocarditis in a patient with epidermolytic hyperkeratosis: A case report
Yu Chen, Dian Chen, Hao Liu, Chen-Guang Zhang, Lin-Lin Song
Yu Chen, Chen-Guang Zhang, Lin-Lin Song, Department of Emergency, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
Dian Chen, Department of Dermatology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
Hao Liu, Department of Pathology, Beijing Tsinghua Changgung Hospital, Beijing 102218, China
Author contributions: Chen Y and Song LL analyzed the data and wrote the manuscript; Liu H and Chen D contributed new pathological datum and analytic tools; Zhang CG designed the research study; All authors have read and approve the final manuscript.
Informed consent statement: All study participants provided informed written consent prior to study enrollment.
Conflict-of-interest statement: We declare that we have no financial and personal relationships with other people or organizations that can inappropriately influence our work, there is no professional or other personal interest of any nature or kind in any product, service and/or company that could be construed as influencing the position presented in, or the review of, the manuscript entitled.
CARE Checklist (2016) statement: The authors have read the CARE Checklist (2016), and the manuscript was prepared and revised according to the CARE Checklist (2016).
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Received: September 16, 2022 Peer-review started: September 16, 2022 First decision: November 11, 2022 Revised: November 21, 2022 Accepted: December 5, 2022 Article in press: December 5, 2022 Published online: December 26, 2022
Abstract
BACKGROUND
Staphylococcus aureus bacteraemia (SAB) is among the leading causes of bacteraemia and infectious endocarditis. The frequency of infectious endocarditis (IE) among SAB patients ranges from 5% to 10%-12%. In adults, the characteristics of epidermolytic hyperkeratosis (EHK) include hyperkeratosis, erosions, and blisters. Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cell-mediated immunity.
CASE SUMMARY
We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases. After genetic tests, the skin disease was diagnosed as EHK.
CONCLUSION
A breached skin barrier secondary to EHK, coupled with inadequate sanitation, likely provided the opportunity for bacterial seeding, leading to IE and deep-seated abscess or organ abscess. EHK may be associated with skin infection and multiple risk factors for extracutaneous infections. Patients with EHK should be treated early to minimize their consequences. If patients with EHK present with prolonged fever of unknown origin, IE and organ abscesses should be ruled out, including metastatic spreads.
Core Tip: Emergency physicians often encounter patients with fever of unknown origin, some of who present with skin diseases. We hope the case can heighten awareness that, in patients with epidermolytic hyperkeratosis or other skin diseases presented with prolonged pyrexia, infectious endocarditis, Staphylococcus aureus bacteraemia and organ abscess could be identified and treated early to minimize the consequences and avoid further life-threatening episodes.
