Disseminated Methicillin-Resistant Staphylococcus aureus (MRSA) Infection Masquerading as Community-Acquired Meningitis

Methicillin-resistant Staphylococcus aureus(MRSA) causes a wide spectrum of infections ranging from simple cutaneous infections to serious invasive infections, including endocarditis and central nervous system (CNS) infections. Multi-site involvement is not infrequently encountered with MRSA infections. Herein, we present a case of complicated MRSA bacteremia presenting as community-onset meningoencephalitis. A 45-year-old man presented to the emergency department with fever, altered sensorium, and disorientation after receiving diclofenac intramuscular injections. He was diagnosed with meningitis due to MRSA. He was treated with vancomycin and rifampicin. He reported significant low back pain, and lumbaosacral spine MRI showed spondylodiscitis. Moreover, the patient developed right shoulder pain and reduction of movement; a shoulder ultrasound revealed mild joint effusion. As he continued to spike and developed the shoulder pain while on vancomycin/rifampicin, IV linezolid was commenced. As a result, the patient's condition improved and was discharged on oral linezolid followed by cotrimoxazole.