Outcome and follow-up
The patient was diagnosed with a MSSA subcapsular splenic abscess and associated empyema, in the context of being immunosuppressed and recently commencing tocilizumab. Following the identification of MSSA, the patient was changed from empirical antibiotic treatment with intravenous amoxicillin-clavulanic acid to intravenous flucloxacillin monotherapy. There was subsequently a good biochemical and clinical response with normalisation of neutrophilia and a slow downtrend in the CRP to 27 mg/L, after three weeks of intravenous antibiotic therapy and source control with splenic abscess drainage and VATS washout. She was discharged home on oral flucloxacillin monotherapy to complete a four-week total course of antibiotic therapy and made a full recovery. Tocilizumab was ceased, and leflunomide and methotrexate were withheld on discharge in the context of infection, with ongoing follow-up planned with her rheumatologist.