Clinical and Medical Case Reports

Staphylococcus Aureus Infective Endocarditis in an Immunocompetent Patient After Herpes Zoster Skin Infection

Abstract

Hitokazu Tsukao*, Riki Matsukawa, Tsubasa Ueda, Yuva Fujii, Wataru Yamaguchi, Junya Nakaya, Toru Kojima

Certain skin conditions, like atopic dermatitis, pose a risk for the development of skin infections and, in more advanced stages of bacteremia. Consequently, it is hypothesized that skin diseases could play a role in the onset of Infectious Endocarditis (IE). We present a 21-years-old Japanese female with a history of acne vulgaris. Shingles appeared on the patient’s right trunk, thus she consulted a local dermatologist after 9 days, and her condition improved after receiving an antiviral drug. However, 32 days after she developed shingles, she experienced fever and vomiting that did not improve, and presented to a nearby clinic on day 36. She was referred to the hospital on the same day. A medical work-up revealed Staphylococcus aureus in two sets of blood cultures taken upon admission. Transesophageal echocardiography unveiled a 1.7 cm vegetation near the septum of the right ventricular outflow tract, leading to her diagnosis of Infectious Endocarditis (IE), attributed to S. aureus. Chest imaging displayed multiple nodular opacities within her lung fields, interpreted as a complication associated with a septic pulmonary embolism resulting from IE. Empirical treatment with Ceftriaxone (CTRX) + Sulbactam/Ampicillin (SBT/ABPC) was initiated. CTRX+SBT/ABPC was changed to cefazolin monotherapy after identifying the causative organism, and the patient’s condition gradually improved. Our case is a rare as skin disease is not previously regarded as a risk factor that triggers the onset of IE.