Henoch–Schönlein purpura due to methicillin-sensitive Staphylococcus aureus bacteremia from central venous catheterization

Abstract

A 69-year-old Caucasian man was admitted to our hospital because of myocardial infarction. A central venous catheter (CVC) for infusive therapy was inserted. After two weeks he developed fever, purpura, and knee arthralgia. Hemoculture yielded methicillin-sensitive Staphylococcus aureus. Subsequently, oliguric renal failure, hematuria, and nephrotic range proteinuria were recorded. Renal biopsy showed mesangial proliferation and crescent formation. In an immunofluorescence study, IgA, IgG, and C3 deposition in the mesangium and along arteriolar walls were observed. A diagnosis of Henoch-Schönlein purpura associated with infection caused by CVC was made. After administration of antibiotic and steroid therapy, proteinuria was markedly reduced, renal function improved, and purpura disappeared. The association of HSP with methicillin-resistant Staphylococcus aureus has frequently been reported in the literature. We present here a case of HSP in association with MSSA bacteremia from central venous catheterization, a finding not reported previously.

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

“…There are rare previous reports in the literature about Staphylococcus aureus bacteremia having cutaneous manifestations or glomerulonephritis [7][8][9]. This is the first reported case to our knowledge of traumatic-induced MSSA bacteremia presenting as joint pain, vasculitis and glomerulonephritis.…”

Central venous catheter infection-induced Henoch-Schönlein purpura in a patient on hemodialysis

“…8 A case of HSP due to S. aureus bacteriemia from central venous catheterization was reported in 2008. 9 S. aureus induces HSP by producing enterotoxins that act as superantigen. Superantigen can stimulate resting T cells to produce cytokines that promote polyclonal B-cell activation, which increases immunoglobulin production and immunocomplex formation.…”

What is the evidence for prophylactic antibiotic treatment in patients with systemic vasculitides?

“…A study [26] on 55 pediatric patients with HSP described an infectious trigger in 29 cases. A multitude of microorganisms have been associated including Helicobacter pylori [27] and S. aureus [28]. S. aureus infection has also been described in purpura fulminans, a disease characterized by disseminated intravascular coagulation and extensive purpuric skin lesions, which is commonly associated with meningococcal and invasive streptococcal infections [29].…”