Life-Threatening Necrotizing Pneumonia with Panton–Valentine Leukocidin-Producing, Methicillin-Sensitive Staphylococcus aureus in a Healthy Male Co-Infected with Influenza B

A previously healthy male was rushed into a hospital critically ill with confusion, sepsis, and acute respiratory distress syndrome only 43 h after having a normal chest X-ray and with blood samples showing only minimally elevated C-reactive protein. Two days earlier, the patient had returned to his home country, the Faroe Islands, from a 10-day work trip aboard a Scandinavian ship in Colombia. The diagnosis turned out to be an influenza B infection and necrotizing pneumonia with Panton–Valentine leukocidin (PVL)-producing methicillin-sensitive Staphylococcus aureus (MSSA). It was influenza season in Colombia but not in the Faroe Islands. The frequency of MSSA with PVL-encoding genes among pediatric infection patients is very low in the Kingdom of Denmark and Faroe Islands and very high in Colombia, and the frequency generally varies highly by region. The patient in this case now suffers severe sequelae from the infection. With this case, we would like to remind clinicians of this rare but severe condition. PVL-producing S. aureus pneumonia should be considered in critically ill, previously healthy patients, especially during influenza season and if the patient has been traveling in countries with high frequencies of PVL-producing S. aureus.

Necrotizing pneumonia caused by methicillin-resistant Staphylococcus aureus

We report a fatal case of methicillin-resistant Staphylococcus aureus (MRSA)-induced necrotizing pneumonia that was refractory to adequate vancomycin treatment (trough value, 13.1 µg/mL), drainage of a hydropneumothorax, and veno-arterial extracorporeal membrane oxygenation. MRSA infection can cause rapidly progressive disease with a high case fatality rate, even with appropriate treatment.

An uncommon organism causing necrotizing pneumonia in a toddler

Necrotizing pneumonia (NP) is an uncommon complication of bacterial pneumonia in children, which must be looked into if a severe pneumonia has poor response to recommended antibiotics. The present case is a toddler with NP in whom fever and cough persisted despite treatment with first-line antimicrobial therapy, computed tomography (CT) scan revealed consolidation with multiple cavities, pseudomonas aeruginosa was the pathogen isolated from bronchoalveolar lavage, which a very uncommon organism is causing NP. Community acquired necrotizing pneumonia caused by pseudomonas is not reported in paediatric population. Hence, we report this case.