Methicillin-resistant Staphylococcus aureus (MRSA) infection of the temple region of the face: Case report.

rationaleA carbuncle is a type of superficial soft-tissue infection involving hair follicles, typically starting as a furuncle. Multiple furuncles can coalesce to form a carbuncle. Methicillin-resistant Staphylococcus aureus (MRSA) is a common commensal organism on the skin and is known to cause infections, particularly in hospitalized patients or those living in nursing homes. This case report describes a patient with a right facial carbuncle complicated by co-infection with COVID-19 and drug toxicity. PATIENT CONCERNS: A 73-year-old Malaysian Chinese woman with a history of chronic hypertension, diabetes mellitus, dyslipidemia, and cerebrovascular accident presented to the Emergency Department with dehydration, acute kidney injury, and a right temple carbuncle with pre-septal involvement. DIAGNOSES: A definitive diagnosis of the infection was made through a swab of the carbuncle pus, which was sent for microorganism culture and sensitivity testing.

interventionsAt the Emergency Department, the patient was initially treated with intravenous (IV) ampicillin-sulbactam (Unasyn) 1.5 g 3 times daily. Despite this, the right facial swelling increased in size. On the fourth day of admission, IV metronidazole 500 mg 3 times daily was added, resulting in a notable reduction in swelling. Incision and drainage of the carbuncle were performed under local anesthesia, followed by daily wound dressings with diluted povidone-iodine solution. Based on blood culture and sensitivity results confirming MRSA infection, IV Unasyn and metronidazole were replaced with vancomycin 2 g initially, then adjusted to 1 g twice daily. However, vancomycin was discontinued after 3 days due to hyperkalemia, and oral Bactrim was initiated. The wound was dressed with hydrogen peroxide and povidone-iodine for their synergistic effects. The infection was effectively managed, leading to progressive wound healing. OUTCOMES: Complete healing of the MRSA-infected skin and soft tissue wound by secondary intention was achieved by the 7th week posthospital admission. LESSONS: Localized MRSA infections of the face can be effectively managed with a combination of medical and surgical interventions. The defect in the temple area healed by secondary intention, resulting in an acceptable cosmetic outcome.