Case Report
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World J Gastroenterol. Jul 21, 2013; 19(27): 4418-4421
Published online Jul 21, 2013. doi: 10.3748/wjg.v19.i27.4418
Crohn’s disease complicated by intestinal infection with methicillin-resistant Staphylococcus aureus
Dominik Bettenworth, Tobias M Nowacki, Alexander Friedrich, Karsten Becker, Johannes Wessling, Jan Heidemann
Dominik Bettenworth, Tobias M Nowacki, Jan Heidemann, Department of Medicine B, University of Münster, D-48149 Münster, Germany
Alexander Friedrich, Institute of Hygiene, University of Münster, D-48149 Münster, Germany
Karsten Becker, Institute of Medical Microbiology, University of Münster, D-48149 Münster, Germany
Johannes Wessling, Department of Clinical Radiology, University of Münster, D-48149 Münster, Germany
Author contributions: Bettenworth D, Nowacki TM and Heidemann J wrote the manuscript and analyzed the literature; Heidemann J performed endoscopy and provided endoscopic images; Becker K and Friedrich A performed polymerase chain reaction, analyses of methicillin-resistant Staphylococcus aureus clone; Wessling J provided scans of abdominal magnetic resonance imaging.
Correspondence to: Dominik Bettenworth, MD, Department of Medicine B, University of Münster, Albert-Schweitzer-Campus 1, D-48149 Münster, Germany. dominik.bettenworth@ukmuenster.de
Telephone: +49-251-8347661 Fax: +49-251-8347570
Received: February 3, 2013
Revised: March 24, 2013
Accepted: April 27, 2013
Published online: July 21, 2013
Abstract

We report on a 24-year-old male patient with history of bloody diarrhea, abdominal pain and vomiting. Endoscopy revealed massive ulcerative discontinuous proctosigmoiditis with deep, sharply demarcated epithelial denudations and enterotoxigenic methicillin-resistant Staphylococcus aureus (MRSA) was detected in mucosal biopsies. After treatment with linezolide and steroids, a significant amelioration of colitis was detected and testing for MRSA became negative. In face of the case presented here, we suggest that in patients with refractory inflammatory bowel disease (IBD), microbiological assessment should be performed to detect a possible Staphylococcus aureus infection in order to initiate an antimicrobial treatment in addition to IBD-specific treatment.

Keywords: Inflammatory bowel disease, Crohn’s disease, Infectious colitis, Staphylococcus aureus, Methicillin-resistant Staphylococcus aureus

Core tip: The case presented here displays the complex situation of Crohn’s disease aggravated by an intestinal bacterial infection, which is a commonly observed clinical scenario. However, the presence of enterotoxigenic methicillin-resistant Staphylococcus aureus (MRSA) in colonic mucosal biopsies is a very rare finding. Nevertheless, in face of the increasing prevalence of MRSA infections, clinicians should be aware of unusual opportunistic infections demanding a sophisticated antimicrobial screening and treatment to be combined with inflammatory bowel disease - specific medical therapy.