Muñoz CA, Bellón AS, Oujo ÁE, Rodríguez Tubio-Dapena S, Merino HA, Rodríguez CJL

Language: Spanish
References: 25
Page: 83-88
PDF size: 548.36 Kb.

ABSTRACT

Introduction: Staphylococcus aureus is a bacterium capable of producing a great variety of infections with a wide range of severity. Panton-Valentine leukocidin (PVL) is an exotoxin with proinflammatory and cytotoxic effects, and its presence is associated with increased severity, especially in cases of necrotizing pneumonia.
Case Report: A 5-month-old infant presented at the emergency room with fever and weakness for 24 hours, developing symptoms compatible with septic shock and requiring repeated volume expansions, inotropic drugs, antibiotherapy and mechanical ventilation. Physical examination revealed cellulitis in the right lower limb, requiring fasciotomy due to compartment syndrome. Laboratory tests showed leukopenia and dismisignificant elevation of acute phase reactants. During admission he developed acute respiratory distress syndrome with hypoxemia refractory to nitric oxide and high frequency ventilation, requiring extracorporeal membrane oxygenation for twelve days. Initially, he was treated with cefotaxime and vancomycin and after identification of Methicillin-resistant S. aureus (MRSA) and suspicion of PVL, antibiotic therapy was changed to ceftaroline and clindamycin. In addition, he receives treatment with immunoglobulins and plasmapheresis. Pulmonary CT 3 weeks after admission showed multiple pulmonary abscesses. He presented progressive improvement with extubation 27 days after admission, without subsequent complications. He remains asymptomatic from the respiratory point of view to the present day (1 year old).
Conclusions: There is an increased incidence of severe infections due to MRSA producing PVL. Early suspicion is important in previously healthy children with acute respiratory worsening and leukopenia. Treatment should include an anti-staphylococcal antibiotic and another one with anti-toxin effect.

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