A case of purulent spondylitis with iliopsoas/epidural abscess caused by ST8-SCCmecIVl community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA/J), a unique MRSA clone in Japan.

In Japan, a growing prevalence has been noted for infection with ST8 community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA). CA-MRSA/J is one of the major clones of the ST8 CA-MRSA and characterized by subtype IVl-SCCmec, which contains spj encoding a cell wall-anchored surface protein in SCCmec, without carrying Panton-Valentine leukocidin (PVL) genes and arginine catabolic mobile element (ACME), unlike the USA300 clone. A 44-year-old woman was admitted to a hospital due to neck pain and lower back pain, associated with eczema and a slight fever. Presence of purulent spondylitis at the cervical (C5-C6) and lumbar (L4-L5) levels was revealed by magnetic resonance imaging, with blood culture being positive for methicillin-resistant S. aureus (MRSA). Subsequently, iliopsoas abscess and epidural abscess in the lumbar spine were detected by enhanced computed tomography. The abscess of the patient resolved by vancomycin, subsequently, daptomycin and minocycline, while taking more than 40 days. The MRSA isolate from venous blood was genotyped as ST8/spa-t1767/coa-IIIa, having SCCmec IVl, without PVL genes and ACME, showing the typical features of CA-MRSA/J. This isolate harbored toxin genes encoding TSST-1 (tst-1), SEC (sec), SEL (sel), epidermal cell differentiation inhibitor (edinA), a novel enterotoxin SE1 (se1), and resistance genes to aminoglycosides (aac(6')-Ie-aph(2")-Ia, aph(3')-IIIa), antiseptic (qacA/B), and cadmium (cadD).