RESUMO
Methicillin-resistant Staphylococcus aureus USA300, belonging to sequence type (ST) 8, is a rare cause of necrotizing fasciitis in the USA. We herein report a case of monomicrobial Fournier's gangrene caused by an ST8, methicillin-susceptible Staphylococcus aureus (designated ksw1). Whole-genome sequencing and analyses for virulence determinants revealed that, unlike USA300, ksw1 lacked virulence genes, such as Panton-Valentine leukocidin and SCCmec, while harboring the toxic shock syndrome toxin-1 gene. These genomic features correlate with ST8 CA-MRSA/J, which is the major genotype of ST8 in Japan.
Assuntos
Toxinas Bacterianas/efeitos adversos , Enterotoxinas/efeitos adversos , Gangrena de Fournier/etiologia , Gangrena de Fournier/microbiologia , Leucocidinas/efeitos adversos , Meticilina/farmacologia , Infecções Estafilocócicas/tratamento farmacológico , Staphylococcus aureus/genética , Superantígenos/efeitos adversos , Idoso , Gangrena de Fournier/diagnóstico , Gangrena de Fournier/epidemiologia , Genótipo , Humanos , Japão/epidemiologia , Masculino , Fatores de Virulência/genéticaRESUMO
A 66-year-old woman, who was diagnosed with iritis, visited our hospital due to general malaise. A blood analysis revealed hypercalcemia. Computed tomography revealed mediastinal and hilar lymph node hyperplasia. Moreover, 67Gallium scintigraphy demonstrated strong accumulation in the lesions, suggesting sarcoidosis. A core needle biopsy (CNB) of the hypoechoic areas of the thyroid was performed because the patient refused to undergo a bronchoscopic examination. The scattering of slightly acidophilic epithelioid cell granulomas was observed in the pathological examination of the biopsy specimen. Based on this finding, the patient was diagnosed with sarcoidosis. Although sarcoidosis rarely involves the thyroid gland, in the present case, thyroid CNB was an alternative diagnostic method that allowed a pathological diagnosis to be obtained.
