10320              STAPHYLOCOCCAL ENTERITIS 

The patient was a girl aged 13 who had several attacks of breathlessness in the 2½ weeks before admission.  Ten days after the onset she was given penicillin for 4 days by her local doctor.  A further attack precipitated admission to hospital in considerable respiratory distress.  She was moderately cyanosed.  The B.P. was 120/180 and the temperature 37.6oC.  There was reduced air entry in all lung regions, with inspiratory stridor.  The pharynx and larynx were moderately inflamed.  Respiratory distress continued and tracheostomy was necessary.  Pharyngeal swab grew pneumococci.  Swinging fever continued with bloodstained tracheal exudate.  Blood culture was negative, but on the 10th day coagulase positive staphylococci were grown from the sputum and scanty acid-fast bacilli was seen in the direct smear.  Opacities in the lungs increased in size despite treatment with streptomycin, terramycin and INH, and finally circulatory collapse occurred and she died after 3 weeks in hospital.  A postmortem there was advanced staphylococcal pneumonia with abscess formation in both lungs and there were scattered ulcers in the terminal ileum.

The specimen consists of 17 cms of ileum to show 2 of these ulcers, which are regular and ovoid with slightly rolled thickened and congested margins and a relatively smooth base.  The ulcers are apparently located in the Peyer’s patches.  Histology shows shallow acute ulcers with a polymorph exudate in their bases.  Oedema extends out to involve the serous coat.