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A rare complication of empyema: thoracic aorta perforation.

Article Excerpt
This case represents an unusual complication of cellulitis caused by methicillin-resistant Staphylococcus aureus.

The case

A 70-year-old man presented to the emergency department with diffuse abdominal pain that he had had for 2 weeks. Five weeks before presentation, he had finished a 10-day course of cephalexin for cellulitis of the right arm.

The patient's history included prostate cancer with bone metastasis that had been diagnosed 5 years previously. He was treated initially with hormone therapy (leuprolide) alone, with little success. For the past 30 weeks, an experimental chemotherapy regimen of interleukin-6 antagonist in combination with prednisone (10 mg/d) was added. His medications also included aspirin and zoledronic acid.

Physical examination revealed no bowel sounds, diffuse abdominal tenderness, blood pressure of 158/102 mm Hg, pulse of 98 beats per minute, temperature of 37[degrees]C (98.6[degrees]F), and no respiratory distress. An intestinal obstruction series and a CT scan of the abdomen showed an ileus but no obstructing mass (Figure 1).

[FIGURE 1 OMITTED]

The results of the laboratory workup were significant only for a white blood cell (WBC) count of 17.8 X [10.sup.3]/[micro]L, with 91% neutrophils. Stool samples were negative for Clostridium difficile toxin. A chest radiograph obtained on admission demonstrated a moderate left-sided pleural effusion (Figure 2).

The patient was empirically treated with broad-spectrum antibiotics. He was given imipenem/...

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