CASE PRESENTATION

A 60- year- old man presented to the emergency

department with fever (40°C) and
change in mental status. His wife mentioned that on the
day before presentation
he was nauseated and vomiting, which was initially
attributed to gastroenteritis.
He had surgery for acute cholecystitis 4 weeks before this
presentation, and his
postoperative course was complicated by purulent
drainage from the surgical
site. Upon arrival at the emergency department, he had a
toxic appearance; his
blood pressure was 90/ 60 mm Hg, his heart rate was 140
beats per minute, and
his respiratory rate was 38 breaths per minute. In
addition, he had diffuse macular
erythema of the trunk and extremities but normal
mucous membranes.
Initial laboratory tests showed leukocytosis (white blood
cells 26×109/ L),
thrombocytopenia (platelets 97×109/ L; platelets
decreased further to
34×109/ L within 48 hours after admission), acute kidney
injury (serum
creatinine 5.3 mg/ dL), elevated lactate (12.5 mmol/ L),
and normal liver
function test results. Deep swab culture of the abdominal
wound grew
Staphylococcus aureus.