Abstract
The patient was a 68-year-old woman. At age 61, she was diagnosed with breast cancer that was cured by surgery, chemotherapy, and radiotherapy. On February 3, 1998, she consulted a local physician for malaise. She had a leukocyte count of 1, 950/mm3 with 28% myeloblasts containing Auer bodies, suggesting a diagnosis of acute leukemia. On February 3, 1998, she was referred to our department and was admitted on the same day. A diagnosis of acute myelocytic leukemia was made by bone marrow aspiration, and the patient received remission induction therapy with idarubicin and cytarabine from February 9 to 15. Filgrastim (granulocyte-colony stimulating factor) was administered intravenously (300mg/day) beginning on February 10 for neutropenia. On February 24, myelosuppression occurred and fever with chills developed. Blood culture revealed methicillin-resistant Staphylococcus aureus (MRSA), indicating a diagnosis of MRSA sepsis. On February 26, the patient noted tenderness in her lower left jaw, that was following by the appearance of a subcutaneous mass the size of a walnut. An intramuscular mass the size of the tip of the little finger was also observed on the extensor aspect of the right leg. Aspiration biopsy of the cervical mass was performed on March 9, and culture revealed MRSA, indicating a diagnosis of subcutaneous and intramuscular MRSA abscess. Since abscesses are prone to hemorrhage and fistula formation in patients with thrombocytopenia, and they are difficult to resect or drain, healing is often delayed, and the risk of disseminated infection is increased. Accordingly, intravenous antibiotic therapy with panipenem/betamipron (PAPM/BP) 2g/day and vancomycin (VCM) 2g/day was given until March 21, but the patient's condition failed to improve. Treatment was changed to intravenous arbekacin (ABK) 200 mg/day and oral minocycline (MINO) 200mg/day, and the masses resolved on April 20. Although the organism was sensitive (MIC:≤4μg/mL) to both VCM and ABK, combined therapy with ABK and MINO proved to be superior.
