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- W2978066311 abstract "Purpose: History: A 16 year old female presented with bloody diarrhea and a recent diagnosis of ulcerative colitis (UC). Medications included mesalamine since diagnosis and steroids over the past two weeks. Once the steroids were discontinued, symptoms escalated to 15 episodes of bloody diarrhea daily with nighttime stooling, crampy abdominal pain, and subjective fevers. Physical Exam and Lab Studies Exam revealed a well-nourished female in moderate distress due to abdominal pain. Her abdomen was tender in the left lower quadrant, bowel sounds were present, no guarding nor rebound tenderness. Exam was otherwise unremarkable. Abnormal labs included WBC 23,360, Hgb 10.4 g%, ESR 36, platelets 364,000, Albumin 2.8g%, CRP 37.4, and IBD-7 panel consistent with UC. Stool was positive for C. difficile toxin A. Hospital Course The patient was started on methylprednisolone 20 mg IV q12 hours and metronidazole 500 mg IV q8 hours. Repeat C. difficile toxin was negative; however, symptoms had not improved, so methylprednisolone was gradually increased to 60 mg IV q6 hours. She had some improvement, but methylprednisolone wean was not tolerated, with increasing abdominal pain, bloody diarrhea, and fever up to 102F. Flexible sigmoidoscopy ruled out CMV infection and C. difficile colitis. Due to persistent severe colitis, infliximab was infused at a dose of 5 mg/kg. Within 24 hours, the patient noticed significant improvement in symptoms; however, she also noticed a 2 mm, pinpoint, erythematous, pruritic lesion on her right leg. Four more identical lesions appeared on her extremities and all evolved into 2 cm, mildly-tender, red-ringed, pus-filled lesions with necrotic centers. Pathologic evaluation was inconsistent with neutrophilic dermatosis, and culture of the lesion grew methycillin resistant staphylococcus aureus (MRSA). Discussion The degree of immunesuppression was likely the turning factor for the appearance of MRSA. The high dose and prolonged course of steroids were probably the most important factors; however, infliximab may have prompted the appearance of the abscesses due to its mechanism of action. Infliximab's effect on NADPH oxidase may impair the oxidative burst, increasing the susceptibility to catalase-positive infections such as MRSA." @default.
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- W2978066311 date "2011-10-01" @default.
- W2978066311 modified "2023-10-18" @default.
- W2978066311 title "Infliximab and Methycillin Resistant Staphylococcus aureus in Ulcerative Colitis" @default.
- W2978066311 doi "https://doi.org/10.14309/00000434-201110002-01080" @default.
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