Successful use of venovenous extracorporeal membranous oxygenation in a 22-month old boy with necrotizing pneumonia, osteomyelitis and septic shock caused by Panton Valentine leukocidin – producing Staphylococcus aureus

Abstract

Extracorporeal membrane oxygenation (ECMO) is a life saving treatment for patients with severe respiratory failure. We present a case of a young child with invasive Panton Valentine leukocidin-producing Staphylococcus aureus infection, which is responsible for severe and invasive infection with a high mortality rate, commonly associated with necrotizing pneumonia. Our patient presented with septic shock and necrotizing pneumonia leading to severe respiratory failure, refrac-tory to conventional ventilation means. After 1-day of treatment, venovenous ECMO (VV ECMO) was successfully instituted and inotropic support was gradually decreased. Acute renal failure was managed with peritoneal dialysis and intermittent venovenous hemofiltration. The patient was weaned from ECMO 9-days later and was mechanically ventilated for another 3 weeks. Necrotizing pneumonia with pleuropulmonary complications was finally managed by videothoracoscopy with evacuation of debris and partial pleural decortication. Osteomyelitis was confirmed by positron emission tomography – computed tomography (PET-CT) and was surgically treated. The child was treated with antistaphylococcal antibiotic therapy for 54 days. Finally, he was discharged to a rehabilitation center without supplemental oxygen and with his neurologic status at his baseline. Our case shows that VV ECMO can be applied to children with severe bacterial pneumonia resistant to conventional ventilation strategies and with moderate circulatory failure.