title: Destructive pulmonary embolism in a patient with community-acquired staphylococcal bacteremia.
abstract: We report a 17-year-old man with destructive pulmonary embolism caused by Staphylococcus aureus bacteremia. The patient was not immunocompromised and had neither underlying diseases nor risk factors, such as concomitant influenza viral infection, which exacerbate staphylococcal infections. The rapid and extensive progression of pulmonary involvement in all lung fields make this a rare case; there have been few reports in the literature describing a similar radiographic appearance in patients with community-acquired staphylococcal bacteremia. In-vitro studies did not demonstrate the production of enterotoxins or toxic shock syndrome toxin 1 (TSST-1) by the isolated strain, but genetic analysis detected Panton-Valentine leukocidine gene from the strain. Subsequent empyema with bilateral pneumothorax was prolonged because of superinfection with both methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Optional surgical treatments, including thoracostomy and thoracopneumoplasty, finally improved his condition.
authors.affiliation: Department of Internal Medicine, Teikyo University School of Medicine, 2-11-1 Kaga, Itabashi-ku, Tokyo 173-8605, Japan. taku@med.teikyo-u.ac.jp
authors.forename: Taku
authors.initials: T
authors.lastname: Miyashita
authors.forename: Yuko
authors.initials: Y
authors.lastname: Shimamoto
authors.forename: Hajime
authors.initials: H
authors.lastname: Nishiya
authors.forename: Yoji
authors.initials: Y
authors.lastname: Koshibu
authors.forename: Hajime
authors.initials: H
authors.lastname: Sugiyama
authors.forename: Yasuo
authors.initials: Y
authors.lastname: Ono
authors.forename: Takayoshi
authors.initials: T
authors.lastname: Satoh
authors.forename: Hitomi
authors.initials: H
authors.lastname: Haraoka
authors.forename: Junichi
authors.initials: J
authors.lastname: Nakano
authors.forename: Ken
authors.initials: K
authors.lastname: Ohta
authors.forename: Tomohide
authors.initials: T
authors.lastname: Sato
authors.forename: Naoko
authors.initials: N
authors.lastname: Morinaga
authors.forename: Masatoshi
authors.initials: M
authors.lastname: Noda
mesh_terms: D000293:Adolescent; D016470:Bacteremia / Q000150:complications*; D001427:Bacterial Toxins; D017714:Community-Acquired Infections / Q000150:complications*; D004768:Enterotoxins / Q000633:toxicity; D005098:Exotoxins; D006801:Humans; D007956:Leukocidins / Q000096:biosynthesis / Q000235:genetics; D008297:Male; D011655:Pulmonary Embolism / Q000209:etiology*; D013203:Staphylococcal Infections / Q000150:complications*; D013211:Staphylococcus aureus; D018089:Superantigens
chemical_list: D001427:Bacterial Toxins; D004768:Enterotoxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal