Disseminated Thoracic Methicillin-Resistant Staphylococcus aureus Infection Mimicking Tuberculosis in a Patient on...

An 18-year-old male receiving haemodialysis through a central venous catheter presented with fever, productive cough, night sweats and progressive dyspnoea. Point-of-care ultrasound demonstrated bilateral complex pleural effusions, lung consolidation and a complex pericardial effusion. Initial management targeted severe bacterial sepsis, but computed tomography performed after clinical stabilization revealed bilateral consolidations, cavitary lung lesions and cavitating pulmonary nodules, raising concern for disseminated tuberculosis. GeneXpert testing of sputum, pleural fluid and pericardial fluid was negative, while blood, pleural fluid and catheter tip cultures grew methicillin-resistant Staphylococcus aureus. Despite pleural and pericardial drainage and intravenous vancomycin therapy, the patient deteriorated and died from sepsis. This case highlights how disseminated thoracic MRSA infection may mimic tuberculosis and underscores the value of bedside ultrasound in identifying multi-compartment thoracic suppuration when advanced imaging is delayed.