Severe pyomyositis caused by Panton-Valentine leucocidin-positive methicillin-sensitive Staphylococcus aureus complicating a pilonidal cyst.
BACKGROUND
To our best knowledge, Panton-Valentine leucocidin (PVL)-positive methicillin-sensitive Staphylococcus aureus (MSSA) has not been described yet as cause for severe pyomyositis.


METHODS
We present a 23-year-old apparently healthy male patient without any typical predisposing findings who developed severe pyomyositis secondary to an operated pilonidal cyst. In the follow-up, the patient showed signs of immunocompromisation. The causative agent for purulent infection of multiple muscles was a MSSA strain harbouring PVL toxin.


RESULTS
In the reported case, aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead to recovery from the disease without relapse.


CONCLUSIONS
PVL-positive S. aureus are associated with skin diseases, multiple abscesses and often complicated by severe sepsis and necrotising pneumonia. Under such circumstances, the mortality rate can reach up to 75%. In addition, the PVL toxin can cause immunocompromisation and might be therefore involved in the aetiology of pyomyositis. Aggressive antibiotic and surgical treatment with additional application of immunoglobulins is recommended for treatment.
Centre for Operative Medicine, Department of Surgery I, University of Würzburg, Oberdürrbacher Str. 6, 97080 Würzburg, Germany. u.lorenz@mail.uni-wuerzburg.de
Udo
U
Lorenz
Marianne
M
Abele-Horn
Dieter
D
Bussen
Arnulf
A
Thiede
D000038:Abscess / Q000382:microbiology / Q000601:surgery; D000328:Adult; D001427:Bacterial Toxins / Q000032:analysis*; D001431:Bacteriological Techniques; D002081:Buttocks / Q000601:surgery; D003646:Debridement; D003937:Diagnosis, Differential; D018450:Disease Progression; D004322:Drainage; D042241:Early Diagnosis; D005098:Exotoxins / Q000032:analysis*; D006801:Humans; D007956:Leukocidins / Q000032:analysis*; D008279:Magnetic Resonance Imaging; D008297:Male; D016106:Methicillin Resistance; D010864:Pilonidal Sinus / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery*; D011183:Postoperative Complications / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery*; D052880:Pyomyositis / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery*; D012086:Reoperation; D018805:Sepsis / Q000175:diagnosis / Q000382:microbiology / Q000601:surgery; D013203:Staphylococcal Infections / Q000175:diagnosis / Q000382:microbiology* / Q000601:surgery; D013211:Staphylococcus aureus / Q000472:pathogenicity*; D014774:Virulence
D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin