A 72 year-old professional musician from North America was admitted with high fever, malaise and multiple painful skin lesions (see image).

He had suffered similar symptoms before, having had then distal necrosis of two fingers.

A cardiac ultrasound was normal.

What do you think is the cause of the illness and what treatment would you recommend?

This patient was an active intravenous drug user and the cutaneous abscesses were produced through venepunctures in poor hygienic conditions.

Methicillin sensitive Staphylococcus aureus was isolated from the abscesses. Surgical drainage and intravenous cloxacillin cured the infection.

Older age does not exclude intravenous drug abuse.