Panton-Valentine Leucocidin-Positive Staphylococcus Aureus Gonarthritis in a Healthy Adult Leads To Fulminant Sepsis with Multiple Metastatic Soft Tissue Infection and Necessity of Extracorporeal Membrane Oxygenation

Abstract

Background: Infections with Panton-Valentine leucocidin (PVL) positive Staphylococcus aureus ( S. aureus ) are often complicated by necrotizing pneumonia, myositis and osteomyelitis. Case Description: We describe a 50 years old, previously healthy male which presented a severe infection with PVL-positive, methicillin- susceptible S. aureus (MSSA) in his left knee after returning from China. He developed a fulminant sepsis with necrotizing pneumonia, acute respiratory distress syndrome (ARDS), acute renal failure and multiple soft tissue abscesses. Extra-corporeal membrane oxygenation (ECMO) was needed for five days. The patient recovered after multiple surgical interventions and long-term antibiotic treatment and eventually returned to work five months after initial admission. Conclusion: While most staphylococcal skin and soft tissue infections (SSTI) show a favorable outcome, SSTI caused by PVL- positive bacteria can lead to fulminant and fatal disease manifestations. Immunocompetent individuals are equally affected as immunocompromised ones. Early suspicion, surgical intervention with debridement and drainage of abscess formations are of key importance in concert with appropriate antibiotic therapy without delay. Imaging should be done to identify clinically silent foci.