{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T05:06:05Z","timestamp":1779771965097,"version":"3.53.1"},"reference-count":22,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T00:00:00Z","timestamp":1779753600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Endocrinol."],"abstract":"<jats:sec>\n                    <jats:title>Purpose<\/jats:title>\n                    <jats:p>\n                      To assess methicillin-resistant\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (MRSA) bloodstream dissemination risk from moxibustion burns in type 2 diabetes and raise awareness of iatrogenic skin injuries in high-risk populations.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>\n                      <jats:italic>Staphylococcus aureus<\/jats:italic>\n                      (\n                      <jats:italic>S. aureus<\/jats:italic>\n                      ) causes bloodstream and metastatic infections, with a mortality rate up to 30%. In diabetic patients, minor skin injuries can lead to fatal systemic infections due to immune dysfunction and neuropathy. Moxibustion is widely used for chronic pain, but its thermal safety in high-risk groups is under-evaluated. Multiorgan MRSA dissemination involving the vertebrae, epidural space, chest wall, liver, lungs, and lymph nodes is extremely rare and challenging.\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Case presentation<\/jats:title>\n                    <jats:p>We report the case of a 61-year-old male patient with type 2 diabetes mellitus and peripheral neuropathy. He developed second-degree burns with bleeding on the lower back following moxibustion therapy for back pain. The initial symptom was fever, followed by progressive bilateral lower limb weakness, urinary retention, and acute neurological deterioration. Laboratory tests revealed significantly elevated white blood cell count and inflammatory markers. Blood and wound cultures were both positive for MRSA. Thoracic spine MRI showed T8\u2013T9 vertebral osteomyelitis and an epidural abscess with spinal cord compression. PET-CT further revealed a right chest wall abscess, a micro-abscess in liver segment S2, right upper lobe pneumonia, and mediastinal and hilar lymph node involvement. The patient was diagnosed with MRSA bloodstream dissemination secondary to moxibustion-induced burns. He received vancomycin for 6 weeks and local debridement but refused surgical drainage due to financial constraints. Although the infection was controlled, paraplegia and urinary retention persisted. The patient remains under follow-up.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>This case highlights that even minor burns caused by moxibustion in poorly controlled diabetic patients can serve as an occult portal for MRSA dissemination. Therefore, it is essential to routinely screen for peripheral neuropathy in diabetic patients before heat therapy and to perform strict skin monitoring afterward. For diabetic patients presenting with unexplained fever and neurological deficits, early blood and wound cultures as well as comprehensive imaging should be performed. Safety protocols for the application of traditional heat therapies in high-risk populations are urgently needed to address the current clinical safety gap.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3389\/fendo.2026.1860646","type":"journal-article","created":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:50:08Z","timestamp":1779771008000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Case Report: Moxibustion-induced burns leading to disseminated methicillin-resistant Staphylococcus aureus infection in a patient with type 2 diabetes mellitus"],"prefix":"10.3389","volume":"17","author":[{"given":"Hong","family":"Liang","sequence":"first","affiliation":[{"name":"The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology","place":["Liuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zhen-Fang","family":"Mao","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology","place":["Liuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jin-Yu","family":"Huang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology","place":["Liuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yang","family":"Yang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology","place":["Liuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Xue-Mei","family":"Li","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology","place":["Liuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jie-Feng","family":"Mao","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology","place":["Liuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Qi","family":"Li","sequence":"additional","affiliation":[{"name":"Changde Hospital, Xiangya School of Medicine, Central South University (The First People\u2019s Hospital of Changde City)","place":["Changde, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yun-Bo","family":"Zhang","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology","place":["Liuzhou, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Wu-Xiao","family":"Wei","sequence":"additional","affiliation":[{"name":"The First Affiliated Hospital of Guangxi University of Science and Technology, Guangxi University of Science and Technology","place":["Liuzhou, China"]},{"name":"Youjiang Medical University for Nationalities","place":["Baise, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2026,5,26]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"239","DOI":"10.1186\/s40168-022-01419-4","article-title":"Staphylococcus aureus populations from the gut and the blood are not distinguished by virulence traits\u2014a critical role of host barrier integrity","volume":"10","author":"Raineri","year":"2022","journal-title":"Microbiome"},{"key":"B2","doi-asserted-by":"publisher","first-page":"798-808","DOI":"10.1001\/jama.2025.4288","article-title":"Management of Staphylococcus aureus bacteremia","volume":"334","author":"Tong","year":"2025","journal-title":"Jama"},{"key":"B3","doi-asserted-by":"publisher","first-page":"132","DOI":"10.1038\/s41392-025-02175-1","article-title":"Diabetic neuropathy: cutting-edge research and future directions","volume":"10","author":"Yang","year":"2025","journal-title":"Signal Transduct Target Ther"},{"key":"B4","doi-asserted-by":"publisher","DOI":"10.1016\/S1474-4422(22)00188-0","article-title":"Towards prevention of diabetic peripheral neuropathy: clinical presentation, pathogenesis, and new treatments","volume":"21","author":"Elafros","year":"2022","journal-title":"Lancet Neurol"},{"key":"B5","doi-asserted-by":"publisher","DOI":"10.4093\/dmj.2025.0508","article-title":"Diabetes mellitus and infectious diseases: current evidence and clinical implications","volume":"49","author":"Kim","year":"2025","journal-title":"Diabetes Metab J"},{"key":"B6","doi-asserted-by":"publisher","DOI":"10.1016\/j.cmi.2015.03.024","article-title":"Pathophysiology and burden of infection in patients with diabetes mellitus and peripheral vascular disease: focus on skin and soft-tissue infections","volume":"21","author":"Dryden","year":"2015","journal-title":"Clin Microbiol Infect"},{"key":"B7","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1664326","article-title":"Effectiveness and mechanism of moxibustion in treating chronic non-specific low back pain: study protocol for a multicenter randomized controlled trial","volume":"12","author":"Wang","year":"2025","journal-title":"Front Med"},{"key":"B8","doi-asserted-by":"publisher","DOI":"10.3389\/fmed.2025.1664326","article-title":"Traditional Chinese medicine treatment strategies for primary dysmenorrhea","volume":"16","author":"Duan","year":"2025","journal-title":"Front Endocrinol"},{"key":"B9","doi-asserted-by":"publisher","first-page":"81","DOI":"10.1016\/j.idc.2020.10.003","article-title":"Staphylococcal skin and soft tissue infections","volume":"35","author":"Hatlen","year":"2021","journal-title":"Infect Dis Clinics North America"},{"key":"B10","doi-asserted-by":"publisher","first-page":"fuae00","DOI":"10.1093\/femsre\/fuae002","article-title":"The role of human extracellular matrix proteins in defining Staphylococcus aureus biofilm infections","volume":"48","author":"Bhattacharya","year":"2024","journal-title":"FEMS Microbiol Rev"},{"key":"B11","doi-asserted-by":"publisher","first-page":"102944","DOI":"10.1016\/j.arr.2025.102944","article-title":"Global and regional burden of 34 key pathogens in the elderly population in 2021: a systematic analysis of the global burden of disease study 2021","volume":"113","author":"Chen","year":"2026","journal-title":"Ageing Res Rev"},{"key":"B12","doi-asserted-by":"publisher","first-page":"51","DOI":"10.1016\/j.mib.2020.02.005","article-title":"Staphylococcus aureus bloodstream infections: pathogenesis and regulatory mechanisms","volume":"53","author":"Kwiecinski","year":"2020","journal-title":"Curr Opin Microbiol"},{"key":"B13","doi-asserted-by":"publisher","DOI":"10.4082\/kjfm.2013.34.5.364","article-title":"Pyogenic liver abscess following acupuncture and moxibustion treatment","volume":"34","author":"Choi","year":"2013","journal-title":"Korean J Fam Med"},{"key":"B14","doi-asserted-by":"publisher","DOI":"10.1016\/j.clineuro.2017.02.019","article-title":"Characteristics and predictors of outcome of spontaneous spinal epidural abscesses treated conservatively: a retrospective cohort study in a referral center","volume":"156","author":"Spernovasilis","year":"2017","journal-title":"Clin Neurol Neurosurg"},{"key":"B15","doi-asserted-by":"publisher","DOI":"10.3389\/fmicb.2020.01479","article-title":"Advanced glycation end products enhance biofilm formation by promoting extracellular DNA release through sigB upregulation in Staphylococcus aureus","volume":"11","author":"Xie","year":"2020","journal-title":"Front Microbiol"},{"key":"B16","doi-asserted-by":"publisher","first-page":"ziad005","DOI":"10.1093\/jbmrpl\/ziad005","article-title":"Staphylococcus aureus Panton-Valentine leukocidin worsens acute implant-associated osteomyelitis in humanized BRGSF mice","volume":"8","author":"Hofstee","year":"2024","journal-title":"JBMR Plus"},{"key":"B17","doi-asserted-by":"publisher","DOI":"10.1016\/j.micinf.2004.12.014","article-title":"Anti-opsonic properties of staphylokinase","volume":"7","author":"Rooijakkers","year":"2005","journal-title":"Microbes Infect"},{"key":"B18","doi-asserted-by":"publisher","first-page":"e01646-20","DOI":"10.1128\/mBio.01646-20","article-title":"Identification of a novel LysR-type transcriptional regulator in Staphylococcus aureus that is crucial for secondary tissue colonization during metastatic bloodstream infection","volume":"11","author":"Groma","year":"2020","journal-title":"mBio"},{"key":"B19","doi-asserted-by":"publisher","DOI":"10.1097\/RLU.0000000000004958","article-title":"Elevated 68Ga-FAPI-04 activity due to Staphylococcus aureus intracranial infection","volume":"49","author":"Zhang","year":"2024","journal-title":"Clin Nucl Med"},{"key":"B20","doi-asserted-by":"publisher","DOI":"10.1093\/ajhp\/zxaa036","article-title":"Therapeutic monitoring of vancomycin for serious methicillin-resistant Staphylococcus aureus infections: a revised consensus guideline and review by the American Society of Health-System Pharmacists, the Infectious Diseases Society of America, the Pediatric Infectious Diseases Society, and the Society of Infectious Diseases Pharmacists","volume":"77","author":"Rybak","year":"2020","journal-title":"Am J Health Syst Pharm"},{"key":"B21","doi-asserted-by":"publisher","DOI":"10.1016\/j.spinee.2013.10.046","article-title":"Spinal epidural abscesses: risk factors, medical versus surgical management, a retrospective review of 128 cases","volume":"14","author":"Patel","year":"2014","journal-title":"Spine J"},{"key":"B22","doi-asserted-by":"publisher","DOI":"10.1016\/j.amjmed.2018.09.022","article-title":"Spinal emergencies in primary care practice","volume":"132","author":"Babu","year":"2019","journal-title":"Am J Med"}],"container-title":["Frontiers in Endocrinology"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1860646\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,5,26]],"date-time":"2026-05-26T04:50:33Z","timestamp":1779771033000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fendo.2026.1860646\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,5,26]]},"references-count":22,"alternative-id":["10.3389\/fendo.2026.1860646"],"URL":"https:\/\/doi.org\/10.3389\/fendo.2026.1860646","relation":{},"ISSN":["1664-2392"],"issn-type":[{"value":"1664-2392","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,5,26]]},"article-number":"1860646"}}