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A twenty year old college athlete, Ms. G., had arthroscopic knee surgery. Over next week she noticed soft swelling, increasing pain, and a little amount of redness at incision site. In three weeks the incision site had nearly completely healed, but patient’s knee remained swollen and painful.

In addition she was febrile (41.3°C) (pyrexia) and had developed vomiting (or emesis) and diarrhoea. She came to emergency department for treatment. Examination revealed sunburn like rash on her face, mild skin peeling above the eyes and red eyes as well as lips. Her blood pressure was 70 or 50 mm Hg and she had raised white cells but diminished number of platelets. Ms. G. was admitted to the intensive care unit.

After investigating further you uncover the following details. Last year Ms. G. was chosen for the Olympic team. Throughout that year she was as well admitted to the psychiatric hospital since she threatened to kill herself. In addition there were twelve police reports because she threatened her boyfriend with bodily death or harm.
After the surgery you find that throat, urine, nasal and blood cultures were negative for the Streptococcus pyogenes and for Staphylococcus aureus. To alleviate her she received fluid and electrolytes and vasopressors and was treated with the oxacillin.

1. Knowing such new facts is it probable that the disease is psychosomatic?
2. Why was oxacillin chosen?
3. What is molecular mechanism of action by this antibiotic?
4. What is molecular mechanism of the resistance to this antibiotic?

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