'Lost in Nasal Space': Staphylococcus aureus sepsis associated with Nasal Handkerchief Packing
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Updated: Sep 21, 2026

Experimental Human Pneumococcal Carriage
Published on: February 15, 2013
Philipp Koehler1,2, Norma Jung1, Matthias Kochanek1
1Department I of Internal Medicine, Intensive Care Unit, University Hospital of Cologne, Cologne, Germany.
Introduction:
Staphylococcus aureus frequently causes infections in outpatient and hospital settings and can present as a highly variable entity. Typical manifestations are endocarditis, osteoarticular infections or infection of implanted prostheses, intravascular devices or foreign bodies. A thorough diagnostic evaluation with early focus identification is mandatory to improve patient outcome.
Case Report:
We report a case of a 68-year old patient with a history of double allogeneic stem cell transplant for acute myeloid leukemia who developed a S. aureus bacteremia with dissemination, severe sepsis and lethal outcome due to nasal handkerchief packing after nose bleeding.
Conclusion:
A thorough medical examination with further diagnostic work-up is most important in S. aureus blood stream infection to identify and eradicate the portal(s) of entry, to rule out endocarditis, to search for spinal abscesses, osteomyelitis or spondylodiscitis. Adherence to management guides for clinicians must be of major importance to achieve optimal quality of clinical care, and thus improve patient outcome.
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