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BMJ Case Reports 2017; doi:10.1136/bcr-2017-220656
  • Unusual presentation of more common disease/injury
  • CASE REPORT

Persistent bacteraemia caused by Staphylococcus aureus in the gall bladder

  1. Cybele Renault1,3
  1. 1Division of Infectious Diseases and Geographic Medicine, Department of Medicine, Stanford University, Stanford, California, USA
  2. 2Department of Medicine, Stanford University, Stanford, California, USA
  3. 3Division of Infectious Diseases, Department of Medicine, Veterans Affairs Health Care System, Palo Alto, California, USA
  1. Correspondence to Dr Alexander Tin Han Yu, atyu{at}stanford.edu
  • Accepted 20 October 2017
  • Published 8 November 2017

Summary

Staphylococcus aureusbacteraemia (SAB) remains a complex disease with a high associated morbidity and mortality, especially when it is able to establish an occult nidus safe from antimicrobial eradication. Without rapid identification and intervention, the nidus can cause persistent relapse of disease, morbidity and mortality. Having a high clinical suspicion for the foci of occult S. aureus is important, and awareness of potential sites of infection is critical and can be life-saving.

We present a unique case of a 65-year-old man with end-stage renal disease receiving haemodialysis who developed septic shock from SAB. Despite 18 days of appropriate antibiotics, the patient had persistent high-grade bacteraemia until his gall bladder was ultimately percutaneously drained. The day after drainage, he cleared his blood cultures, although he ultimately passed away as he decided to transition his care to focus on comfort measures.

Footnotes

  • Contributors ATHY’s contributions included drafting of the article, literature review and critical revisions of the article.TC’s contributions included drafting of the article, literature review and critical revisions of the article. EB’s contributions included drafting of the article and literature review of the article. CR’s contributions included critical revisions of the article and approval of article. All authors read and approved the final manuscript.

  • Competing interests None declared.

  • Patient consent Obtained.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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