Strategies for Diagnosing and Treating Disseminated Methicillin-Sensitive Staphylococcus aureus Infections: Insights From a Pustular Eruption

A 63-year-old immunocompromised male with a history of renal transplant and stage III large B-cell nonHodgkin lymphoma undergoing rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone (RCHOP) therapy presented with fever and a disseminated pustular eruption. Initial laboratory values indicated septicemia. Differential diagnoses included Sweet's syndrome, septic emboli, and leukocytoclastic vasculitis. Punch biopsies and bacterial cultures confirmed disseminated methicillin-sensitive Staphylococcus aureus (MSSA) infection. Histopathology revealed intraepidermal vesiculopustules and bacterial cocci colonies in the superficial dermis, suggesting hematogenous spread. The patient's indwelling venous access port was identified as the infection source and removed. Treatment included antibiotics such as cefepime, vancomycin, fluconazole, and acyclovir, as well as filgrastim for neutropenia. Following port removal and a four-week course of ceftriaxone, the patient's condition improved. This case highlights the importance of clinicopathologic correlation in diagnosing and managing disseminated staphylococcal infections in immunocompromised patients. The rare presentation of vesiculopustular eruptions secondary to MSSA emphasizes the need for prompt identification and treatment to prevent severe complications. This report contributes to the limited literature on disseminated staphylococcal infections presenting as vesiculopustular eruptions in immunocompromised individuals.