B73-19 An Unusual Case of Community-associated MRSA Bacteremia Presenting With Pulmonary Nodules in the Absence of Endocarditis

Abstract Methicillin-resistant Staphylococcus aureus (MRSA) is a virulent pathogen increasingly identified outside of the healthcare setting. Although traditionally linked to risk factors such as intravenous drug use, prosthetic devices, and indwelling catheters, community-acquired MRSA infections are now being recognized in healthy individuals. We present the case of a 47-year-old male firefighter with a history of asthma and no history of smoking who developed progressive left facial swelling over the course of one week following mechanical rupture of a presumed ingrown facial hair. Despite use of over-the-counter topical treatments, the swelling progressed to involve the lips at which time he was evaluated at an urgent care center. He was prescribed prednisone and diphenhydramine without improvement. He subsequently presented to the emergency department with worsening facial swelling and new onset shortness of breath. Upon presentation to the emergency department the was in moderate respiratory distress requiring non-invasive ventilation via bipap and wheezing of the bilateral lower lung fields was appreciated on physical exam. He received intravenous epinephrine, diphenhydramine, methylprednisolone and inhaled albuterol with some improvement. He was admitted with a working diagnosis of angioedema versus sepsis secondary to cellulitis of the left face and was monitored in the intensive care unit for concern of impending airway compromise. CAT scan imaging of the chest was notable for multiple nodular infiltrates of the bilateral lung fields, the largest measuring 2.4cm in the right upper lobe. Septic workup revealed leukocytosis, elevated inflammatory markers and MRSA bacteremia. He was begun on vancomycin and repeat blood cultures drawn the following day were negative. Endocarditis was ruled out following transthoracic echocardiogram which was also negative for vegetations. While MRSA bacteremia is a recognized cause of septic pulmonary emboli, such findings without evidence of infective endocarditis remains uncommon. Moreover, this patient’s occupational exposure as a firefighter raises the possibility of an inflammatory etiology, as exposure related lung nodules can mimic infectious lesions on imaging. This case underscores the importance of a comprehensive evaluation in patents with MRSA bacteremia, as significant complications may arise despite the absence of tractional risk factors. This abstract is funded by: None