A 62-year-old man with a purpuric rash and acute kidney injury

Abstract

Staphylococcus aureus bacteremia can infrequently present as vasculitis or Acute Glomerulonephritis (AGN). The association between Staphylococcus aureus bacteremia and these immune-mediated responses is rare and remains a diagnostic challenge. We present a case of a 62-year-old man with hypertension, hyperlipidemia, and type II diabetes mellitus who presented with joint pain, hematuria and a purpuric rash in his legs and oral cavity after he dropped a bag of heavy metal on his right foot. He was found to have acute glomerulonephritis with rapidly progressing renal failure requiring emergent hemodialysis. At first, the presentation seemed to be of a rheumatologic origin and he was initially managed with methylprednisolone. However, further work-up revealed methicillin-sensitive Staphylococcus aureus bacteremia. The right toe was amputated for source control and the patient was treated with antibiotics. This case is, to our knowledge, the first reported clinical presentation of Staphylococcus aureus bacteremia manifesting as purpuric rash, glomerulonephritis, and joint pain. It highlights the importance of making an initial differential diagnosis between a rheumatologic and an infectious disorder, as initial suspicion would change initial management and prognosis.