When the Skin Speaks: Methicillin-resistant Staphylococcus aureus Suprapubic Abscess in a Renal Transplant Recipient

Cutaneous infections are common in renal transplant recipients and may represent early indicators of systemic infection due to chronic immunosuppression. Prompt recognition is critical to prevent morbidity and graft dysfunction. We report a 33-year-old male, a live (grandmother to grandson) renal transplant recipient (2019), maintained on tacrolimus, mycophenolate sodium, and steroids, who presented with a 10-day history of low-grade fever and a progressive suprapubic skin lesion. The lesion was erythematous, painful, erosive, and associated with discharge. There were no urinary or systemic localizing symptoms. Examination revealed localized tenderness and warmth. Empirical broad-spectrum antibiotics were initiated, and mycophenolate was withheld. Dermatological evaluation suggested possible herpes zoster; however, surgical exploration revealed a localized abscess. Pus culture was sent which came positive for methicillin-resistant Staphylococcus aureus (MRSA). Antibiotic therapy was escalated to daptomycin, with subsequent clinical improvement and healthy granulation tissue formation. Despite resolution of infection, graft dysfunction persisted with serum creatinine 4.8 mg/dL at discharge. Cutaneous lesions in transplant recipients should be considered potential markers of serious infection. MRSA should be suspected in patients with prior healthcare exposure. Early surgical intervention and targeted antimicrobial therapy are essential to prevent complications and graft survival.