title: Life-threatening hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus.
abstract: Three new consecutive cases of life-threatening hemoptysis in adults with community-acquired pneumonia due to Panton-Valentine leukocidin-secreting Staphylococcus aureus are presented, focusing on the particular clinical presentation of this new entity. Between December 1999 and March 2001, three adults aged from 23 to 67 years were admitted to our respiratory intensive care unit for massive hemoptysis and septic shock associated with community-acquired Staphylococcus aureus pneumonia. Isolates were sent to the Centre National de Référence des Toxémies Staphylococciques in Lyon, France, where they were found to secrete Panton-Valentive leukocidin. The clinical course was similar in the three patients, with massive hemoptysis and septic shock necessitating mechanical ventilation. Two patients died rapidly; necropsy showed pulmonary vascular necrosis in one of them. The third patient recovered after appropriate antibiotic therapy. Leukocidin/neutrophil interactions in the pulmonary vasculature may cause severe hemoptysis in patients with community-acquired Staphylococcus aureus pneumonia secreting Panton-Valentine leukocidin. Adult patients with massive hemoptysis and suspected community-acquired pneumonia should receive antibiotic regimens covering Staphylococcus aureus.
authors.affiliation: Service de Pneumologie et de Réanimation Respiratoire, Hôpital Tenon-Université Paris VI, 4 rue de la Chine, 75020 Paris, France.
authors.forename: Véronique
authors.initials: V
authors.lastname: Boussaud
authors.forename: Antoine
authors.initials: A
authors.lastname: Parrot
authors.forename: Charles
authors.initials: C
authors.lastname: Mayaud
authors.forename: Marie
authors.initials: M
authors.lastname: Wislez
authors.forename: Martine
authors.initials: M
authors.lastname: Antoine
authors.forename: Clément
authors.initials: C
authors.lastname: Picard
authors.forename: Françoise
authors.initials: F
authors.lastname: Delisle
authors.forename: Jérome
authors.initials: J
authors.lastname: Etienne
authors.forename: Jacques
authors.initials: J
authors.lastname: Cadranel
mesh_terms: D000328:Adult; D000368:Aged; D001427:Bacterial Toxins; D017714:Community-Acquired Infections / Q000150:complications; D005098:Exotoxins / Q000378:metabolism*; D006469:Hemoptysis / Q000209:etiology*; D006801:Humans; D007956:Leukocidins / Q000378:metabolism*; D008297:Male; D011023:Pneumonia, Staphylococcal / Q000150:complications*; D013211:Staphylococcus aureus / Q000378:metabolism*
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin