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Received Feb 25, 2018; Accepted Apr 29, 2018
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1. Introduction
Abscess formation in the area between the subscapularis muscle and the chest wall is an infrequently reported entity. A literature search of PubMed using the terms “subscapular” + “abscess” yields only six relevant case reports [1–6], of which one describes a fatal outcome [2].
Panton-Valentine leukocidin (PVL) is a cytotoxin which causes leukocyte destruction and tissue necrosis. The genes encoding for PVL are present in less than 2% of S. aureus species, according to statistics from the UK National Reference Laboratory [7]. Strains of PVL-producing S. aureus have been linked to highly virulent and severe community-acquired skin infections and abscesses in otherwise healthy children and young adults [7]. PVL production is seen much more frequently in S. aureus strains associated with abscesses or deep-seated soft-tissue infection compared with asymptomatic carriage strains [8].
We present a case involving an active adult woman with no predisposing comorbidities who had experienced a number of superficial skin infections in the preceding year and developed an abscess in the subscapular space following trauma, cultures from which grew PVL-producing S. aureus.
2. Case Presentation
A fit and active 38-year-old female presented to the Accident and Emergency Department with a four-day history of worsening right shoulder pain radiating down the right arm, with swelling around the shoulder. This was accompanied by intermittent fevers for the preceding two days. The patient graded the pain to be 8/10 on a visual analogue scale for pain. The patient reported an episode of right shoulder pain three weeks prior to current presentation which developed while she was boxing with a punch bag and resolved spontaneously in 2-3 days without seeking any medical advice.
The patient denied any history of infections in the previous 6 weeks. She had a significant past medical history of cellulitis around the leg 6 months prior and a Bartholin cyst that was treated conservatively 8 months before this presentation. She was not on any routine medications and did not have any predisposing medical conditions such as immunosuppression or diabetes.
At presentation, all her observations...