Necrotizing haemorrhagic pneumonia proves fatal in an immunocompetent child due to Panton-Valentine Leucocidin, toxic shock syndrome toxins 1 and 2 and enterotoxin C-producing Staphylococcus aureus.
Panton-Valentine leucocidin (PVL) toxin-producing strains of Staphylococcus aureus (S. aureus) are associated with skin abscesses and furunculosis, with necrotizing pneumonia being a relatively rare problem. Here, we describe a fatal case of necrotizing pneumonia in a 14-year-old child who presented initially with sore throat and pyrexia. He deteriorated rapidly, developing hypotension, multiple organ failure and purpura fulminans. S. aureus was isolated from the tracheal aspirate, which was found to be positive for PVL, toxic shock syndrome toxins (TSST) 1 and 2 and staphylococcal enterotoxin C (SEC). It was postulated that purpura fulminans and toxic shock syndrome were a result of the abovementioned exotoxins.


CONCLUSIONS
This case highlights the emergence of PVL-positive community-acquired S. aureus infection and association of purpura fulminans with superantigens. Practitioners should be aware of this illness in order to initiate appropriate treatment.
Paediatric Department, South Tyneside NHS Foundation Trust, South Shields, UK.
Farah
F
Mushtaq
Sandra
S
Hildrew
Gabriel
G
Okugbeni
Richard W
RW
Ellis
Sanjay
S
Deshpande
D000293:Adolescent; D001427:Bacterial Toxins / Q000096:biosynthesis*; D004768:Enterotoxins / Q000096:biosynthesis*; D005098:Exotoxins / Q000096:biosynthesis*; D017809:Fatal Outcome; D006470:Hemorrhage / Q000209:etiology*; D006801:Humans; D011695:IgA Vasculitis / Q000209:etiology; D007956:Leukocidins / Q000096:biosynthesis*; D008297:Male; D009102:Multiple Organ Failure / Q000209:etiology; D009336:Necrosis; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis / Q000382:microbiology*; D012772:Shock, Septic / Q000175:diagnosis / Q000382:microbiology*; D013211:Staphylococcus aureus / Q000378:metabolism*; D018089:Superantigens / Q000096:biosynthesis*
D001427:Bacterial Toxins; D004768:Enterotoxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin; D018089:Superantigens; C030107:enterotoxin F, Staphylococcal; C532624:toxic shock syndrome toxin 2, Staphylococcus aureus; C034959:enterotoxin C, staphylococcal