An unusual case of epistaxis and Staphylococcus aureus bacteremia in an older chinese woman.

摘要

An 80-year-old Chinese woman with advanced Alzheimer's disease, ischemic heart disease, hypertension, and hyperlipidemia presented with a 1-week history of recurrent epistaxis and bloody ear discharge. She was a known nasal carrier of methicillin-resistant Staphylococcus aureus (SA) and had been admitted to the hospital three times in recent months for urinary tract infections and lower limb cellulitis. Physical examination was unremarkable. Nasal endoscopy and otoscopy revealed crusting in the nasal cavity with a fleshy mass at the right external auditory canal floor extending posteriorly to the right postnasal space (PNS). In addition, she had a bilateral subtotal perforation of the tympanic membrane and chronic suppurative otitis media. A computed tomography scan detailed the heterogeneous enhancing right PNS mass extending toward the left nasopharynx. Histology revealed extensive necrosis, fibrinopurulent exudates, mixed-type inflammatory infiltrate, and clusters of gram-positive cocci. No malignant cells, granulomas, giant cells, or acid-fast bacilli were seen. Anti-Epstein-barr virus viral capsid antigen titers were normal (immunoglobulin A< 5, early antigen< 5). Because the suspicion of nasopharyngeal carcinoma (NPC) was high, a repeat biopsy was performed that was again negative for malignancy.