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Hereditary haemorrhagic telangiectasia type 1 complicated by recurrent deep-seated MSSA infections necessitating lifelong antibiotic suppression
  1. Evan Paul Tracy1,
  2. Iyanujesu Adereti2,
  3. Justin Chu3 and
  4. Julianna Brown1
  1. 1Medicine, University of Louisville, Louisville, Kentucky, USA
  2. 2Psychiatry, University of Louisville, Louisville, Kentucky, USA
  3. 3Sports Medicine, University of Louisville, Louisville, Kentucky, USA
  1. Correspondence to Dr Julianna Brown; julianna.brown.1{at}louisville.edu

Abstract

Hereditary haemorrhagic telangiectasia (HHT) leads to arteriovenous malformations (AVM) that increase the risk of haemorrhage and cause right-left shunting bypassing the reticuloendothelial system increasing the risk for recurrent infections. A 60+ year old male patient with HHT type 1 (status post six pulmonary AVM coiled embolisations) with epistaxis presented with intractable back pain, methicillin-sensitive Staphylococcus aureus (MSSA) bacteraemia and spinal MRI revealing spondylodiskitis and L4-L5 epidural phlegmon. He has an extensive history of deep-seated infections including two prior spinal infections, two joint infections and one muscular abscess—all with MSSA. The patient was treated with 6 weeks of intravenous nafcillin with symptom resolution. Infectious disease prescribed cefalexin 500 mg daily for suppression of infection recurrence considering his extensive deep-seated infection history and multiple risk factors. This case raises important questions about preventative antimicrobial management of high-risk patients with HHT, which is a grey area in current international HHT guidelines.

  • Infections
  • Bone and joint infections
  • Arteries
  • Cardiovascular system
  • Back pain

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Footnotes

  • Contributors The following authors were responsible for drafting of the text, sourcing and editing of clinical images, investigation results, drawing original diagrams and algorithms, and critical revision for important intellectual content: EPT, IA, JC, JB. The following authors gave final approval of the manuscript: EPT, IA, JC, JB.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Case reports provide a valuable learning resource for the scientific community and can indicate areas of interest for future research. They should not be used in isolation to guide treatment choices or public health policy.

  • Competing interests None declared.

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