Cavitary Pneumonia Due to Methicillin-Resistant Staphylococcus aureus in a Non-Immunocompromised Patient After an Endoscopy: A Case Report

Patient: Male, 32-year-old Final Diagnosis: Pneumonia due methicillin-resistant Staphylococcus aureus (MRSA) Symptoms: Hypoxemia • tonic-clonic seizures Medication: — Clinical Procedure: Bronchoalveolar lavage • lumbar puncture Specialty: Critical Care Medicine • Pulmonology OBJECTIVE: Rare co-existance of disease or pathology BACKGROUND: Methicillin-resistant Staphylococcus aureus (MRSA) pneumonia has well-defined characteristics. We present a case of cavitary pneumonia due to MRSA in a patient who had undergone a recent outpatient gastroscopic procedure. CASE REPORT: A 32-year-old man presented at the Emergency Department with tonic-clonic seizures of 2 min durations. He had a history of seizures without current treatment or use of psychostimulant drugs. His personal history referred to hypothyroidism treated with levothyroxine, morbid type 3 obesity, gastritis with a gastric ulcer, penicillin allergies, and an ambulatory endoscopy with a biopsy (7 days ago) for erosive gastropathy. On the 3(rd) day of admission to the Intensive Care Unit (ICU), a bronchoscopy was performed, which showed a reddened mucosa with hemorrhagic points and a cavitary area in the right main bronchus. Multiple polymerase chain reaction and mass spectrometry analyses of samples of bronchioalveolar lavage from the bronchus revealed MRSA with a mechanism of resistance to the mecA gene (1×10(5) colony-forming unit/mL). The laboratory results for the cerebrospinal fluid were negative for bacterial growth. After 6 days, he was discharged from the ICU, although he remained hospitalized for another 4 days. He was followed up through the Outpatient Department and 6 months later he remains in general good health. CONCLUSIONS: This is a rare case of cavitary pneumonia due to MRSA of clinical and epidemiological characteristics, which is unusual after an outpatient endoscopic procedure.