Abstract
A 21-year-old woman was admitted to the authors' hospital with symptoms of breathlessness, pleuritic chest pain and haemoptysis having been unwell for 1 week with a flu-like illness. Clinical examination revealed a rapid respiratory rate (36/min), tachycardia (134 beats per minute), pyrexia (39°C), bibasal coarse crepitations and bronchial breathing. Investigations showed hypoxia (PO2 12.4 on 100% oxygen), raised inflammatory markers (C-reactive protein 324 mg/litre), thrombocytopenia (platelets 144 × 109/litre), leucopenia (2 × 109/litre) and neutropenia (0.88 × 109/litre). Chest X-ray revealed bilateral air space shadowing (Figure 1). The patient was admitted to the high dependency unit and started on intravenous co-amoxiclav (1.2 g three times per day) and clarithromycin (500 mg twice daily). Blood cultures at 24 hours grew Staphylococcus aureus resistant to penicillin and fusidic acid. The patient was switched to intravenous flucloxacillin. Admission was complicated by the development of a small pleural effusion. The patient was managed with high flow oxygen therapy, did not require ventilatory support at any stage and was discharged home after 17 days. The patient received flucloxacillin for a total of 4 weeks. The S. aureus isolate carried enterotoxins G and I and the Panton-Valentine leucocidin gene. Throat swab was positive for influenza B by a molecular method.
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