Abstract
We report a case of fulminant multiple organ failure including the Acute Respiratory Distress Syndrome (ARDS), haemodynamic, and renal failure due to community-acquired methicillin-sensitive Panton Valentine Leukocidin (PVL) positive spa-type 284 (ST121) Staphylococcus aureus septic shock. The patient's first clinical symptom was necrotizing pneumonia. Despite organism-sensitive triple antibiotic therapy with linezolid, imipenem and clindamycin from the first day of treatment, progressive abscess formation in multiple skeletal muscles was observed. As a result, repeated surgical interventions became necessary. Due to progressive soft tissue infection, the anti-microbial therapy was changed to a combination of clindamycin and daptomycin. Continued surgical and antimicrobial therapy finally led to a stabilisation of the patients' condition. The clinical course of our patient underlines the existence of a "PVL-syndrome" which is independent of in vitro Staphylococcus aureus susceptibility. The PVL-syndrome should not only be considered in patients with soft tissue or bone infection, but also in patients with pneumonia. Such a condition, which may easily be mistaken for uncomplicated pneumonia, should be treated early, aggressively and over a long period of time in order to avoid relapsing infection.
Highlights
Panton Valentine Leukocidin (PVL) positive staphylococcal infection typically presents as life-threateninginfection of soft-tissues and bones [1,2]
PVL-positive staphylococcal infection may lead to necrotizing pneumonia, a condition which can even be observed before the onset of soft-tissue or bone infection [3,4]
The genes encoding the exotoxin PVL are typically present in community-acquired methicillinsensitive S. aureus (CA-methicillin-sensitive Staphylococcus aureus (MSSA)) [3], with about 2–5% of PVL-positive MSSA strains
Summary
Panton Valentine Leukocidin (PVL) positive staphylococcal infection typically presents as life-threateninginfection of soft-tissues and bones [1,2]. Within 6 days of triple antibiotic therapy with linezolid, imipenem and clindamycin, the patient developed progressive respiratory and haemodynamic failure including development of the Acute Respiratory Distress Syndrome (ARDS) requiring mechanical ventilation (FiO2 0.8, paO2 79 mmHg, PEEP 15 cmH2O, peak inspiratory pressure 33 cmH2O). Because of the unusual severity of the staphylococcal infection, community-acquired Panton Valentine Leukocidin (PVL)-positive MSSA septic shock was suspected [1]. This was confirmed by PCR demonstration of the respective PVL-genes, as previously reported by us [11].
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