Research Day
A CASE OF SMALL VESSEL VASCULITIS DUE TO STAPHYLOCOCCUS AUREUS.
Document Type
Abstract
Date
2021
Abstract
Systemic vasculitides are a complex group of disorders that involve multiple organs. The origin of these primary vasculitides is not fully understood, there is a combination of genetic, immunological, and environmental factors, including infections, which may trigger them. An 87-year-old man with a complex medical history presented with confusion, worsening erythema of the lower extremities and decreased urine output. Five-days prior to this presentation, he was hospitalized for right lower extremity cellulitis and abscess, requiring intravenous antibiotics, incision and drainage; cultures of which grew Staphylococcus aureus and group B streptococcus. Exam findings included periorbital edema, end expiratory wheezes, 2+ pitting edema in right lower extremity and palpable, blanching petechiae with purpura involving both lower extremities with associated necrotic lesions. Lab work showed elevated creatinine and BUN compared to his baseline. Urinalysis showed 3+ hemoglobin without proteins and casts. Autoimmune disease and myeloma workup was negative. Hepatitis B, C and HIV were negative. C3 and C4 compliment were 49 and 15 respectively, while total compliment level was normal. Skin biopsy of the two lesions showed concerns of small vessel vasculitis with rare eosinophils. He was diagnosed with Staphylococcus-associated vasculitis, and he was treated with antibiotics. Kidney function failed to improve and hemodialysis was initiated. Staphylococcus-associated vasculitis is mostly linked to immune complex formation and continued antigen production in setting of active infection. Diagnosis requires a biopsy, hypocomplementemia and recent history of staphylococcal infection. Treatment of staphylococcus-associated vasculitis should focus on eradicating the infection while immunosuppressive therapy has no clear benefit.