Published online Dec 26, 2022. doi: 10.12998/wjcc.v10.i36.13418
Peer-review started: September 16, 2022
First decision: November 11, 2022
Revised: November 21, 2022
Accepted: December 5, 2022
Article in press: December 5, 2022
Published online: December 26, 2022
Processing time: 101 Days and 13.2 Hours
Staphylococcus aureus bacteraemia (SAB) is among the leading causes of bacteraemia and infectious endocarditis. The frequency of infectious endocarditis (IE) among SAB patients ranges from 5% to 10%-12%. In adults, the characteristics of epidermolytic hyperkeratosis (EHK) include hyperkeratosis, erosions, and blisters. Patients with inflammatory skin diseases and some diseases involving the epidermis tend to exhibit a disturbed skin barrier and tend to have poor cell-mediated immunity.
We describe a case of SAB and infective endocarditis in a 43-year-old male who presented with fever of unknown origin and skin diseases. After genetic tests, the skin disease was diagnosed as EHK.
A breached skin barrier secondary to EHK, coupled with inadequate sanitation, likely provided the opportunity for bacterial seeding, leading to IE and deep-seated abscess or organ abscess. EHK may be associated with skin infection and multiple risk factors for extracutaneous infections. Patients with EHK should be treated early to minimize their consequences. If patients with EHK present with prolonged fever of unknown origin, IE and organ abscesses should be ruled out, including metastatic spreads.
Core Tip: Emergency physicians often encounter patients with fever of unknown origin, some of who present with skin diseases. We hope the case can heighten awareness that, in patients with epidermolytic hyperkeratosis or other skin diseases presented with prolonged pyrexia, infectious endocarditis, Staphylococcus aureus bacteraemia and organ abscess could be identified and treated early to minimize the consequences and avoid further life-threatening episodes.