Diagnostic approach in persistent Staphylococcus aureus bacteraemia

Staphylococcus aureus is the leading cause of bacteraemia and can lead to complicated infections that may be difficult to diagnose and hence lead to higher morbidity. Failure to identify such could lead to severe complications or relapsing bacteraemia due to inadequate treatment. The authors report a patient presenting with methicillin-resistant S. aureus (MRSA) bacteraemia and septic arthritis, who developed a complicated infection with multiple metastasis and persistent bacteraemia despite adequate treatment. A fluorodeoxyglucose (FDG)-positron emission tomography scan 2 weeks after the initial presentation identified a linear area of intense FDG uptake within the right upper extremity which raised suspicion for an infected thrombus within the right cephalic vein. Adequate treatment of the infected thrombus helped resolve the patient's persistent MRSA bacteraemia and complicated infection. This case highlights the importance of considering suppurative thrombophlebitis in the setting of persistent bacteraemia and metastatic infections due to MRSA.