Microbial skin infection with an unusual course in an immunocompetent woman: analysis of a clinical case

Abstract

We analyzed the clinical case of recurrent infection of the skin in a hospitalized 20-year-old immunocompetent patient female with pustular rash, feverishness and debilitating weakness. The aim of the work was to improve the diagnosis and treatment of infectious skin diseases based on the analysis of this clinical case of recurrent microbial skin infection on the background of atopic dermatitis in an immunocompetent woman. The diagnosis was based on clinical examination, microbiological studies (bacteriological culture of scrapings from the rash elements), laboratory blood tests, and assessment of the effectiveness of antibacterial therapy. Upon admission to the hospital, complaints of a rash located on the face, scalp, and neck, with a feeling of mild pain and itching, as well as a fever within 38º-38.5ºC, and general weakness. The patient was diagnosed with a mixed infection of Streptococcus agalactiae, Staphylococcus aureus, and later Enterococcus faecalis. Initial treatment with cefazolin for 8 days was effective, however, 5 days after the end of the course, the rash relapsed, which was accompanied by increased itching, an increase in body temperature to 37.5ºC, as well as the deterioration of the emotional state, which required the use of a reserve antibiotic – linezolid, and, taking into account atopic dermatitis, a short (5-day) course of systemic corticosteroids was prescribed. During 10 days of treatment, the patient's condition improved, there were no new rashes, the blisters healed and became crusted, itching decreased, and the general and emotional state normalized. However, a week after the end of the course of systemic treatment, the patient again had new elements of the rash. Treatment was continued on an outpatient basis. This clinical case demonstrates that microbial skin infections in non-immunocompromised patients can be severe in the presence of additional risk factors such as atopic dermatitis and occupational exposure. Valid microbiological studies are critical for effective selection of antibiotic therapy. It is recommended that microbial infections of the skin and subcutaneous tissue be included in the national infectious disease registration system for monitoring the effectiveness of treatment and prevention.