Rib destruction with Staphylococcus contiguous abscess after septic pulmonary embolism and tricuspid endocarditis

Excerpt

A 25-year-old smoker, intravenous drug user, non-diabetic, non-hypertensive homeless man presented to the emergency department with fever, dyspnea, cough, weight loss (BMI 19 kg/m²), and chest pain. On general examination, there were two soft, non-tender, non-pulsatile, fluctuant tissue swellings over the right anterior chest wall of insidious onset and progressively increasing in size for 1 week, but no axillary lymphadenopathy and normal skin in other parts of the body. His temperature was 38.5 °C, respiratory rate 35 breaths/min, pulse rate 115 beats/min, and blood pressure 130/60 mmHg. Chest X-ray was abnormal (Fig. 1a). Transesophageal echocardiography demonstrated infectious tricuspid vegetation (Fig. 1b). Ultrasonography of the lateral quadrant of the right breast showed two hypoechoic collections. Chest CT showed destruction of two ribs with contiguous empyema over the right anterior chest wall and nodules consistent with septic pulmonary embolism (Fig. 1c, d). Abscesses were confirmed to be of staphylococcal origin by microbiology studies of the aspirated material obtained under ultrasonography guidance. The patient was treated with antistaphylococcal antibiotics and local chest drainage of pus with complete postoperative recovery. …