Necrotizing pneumonia caused by Panton-Valentine leucocidin-producing Staphylococcus aureus originating from a Bartholin's abscess.
BACKGROUND
Panton-Valentine leukocidin (PVL-)producing Staphylococcus aureus is emerging as a serious problem worldwide. There has been an increase in the incidence of necrotizing lung infections in otherwise healthy young people with a very high mortality associated with these strains. Sporadic severe infectious complications after incision of Bartholin's abcesses have been described but involvement of S. aureus is rare.


METHODS
We present a 23-year-old apparently healthy female patient without any typical predisposing findings who developed severe sepsis with necrotizing pneumonia and multiple abscesses following incision of a Bartholin's abscess. Methicillin-sensitive S. aureus harbouring Panton-Valentine leucocidin genes were cultured from the abscess fluid, multiple blood cultures and a postoperative wound swab. Aggressive antibiotic therapy with flucloxacillin, rifampicin and clindamycin, drainage and intensive supportive care lead finally to recovery.


CONCLUSIONS
S. aureus, in particular PVL-positive strains, should be considered when a young, immunocompetent person develops a fulminant necrotizing pneumonia. Minor infections--such as Bartholin's abscess--can precede this life-threating syndrome. Bactericidal antistaphylococcal antibiotics are recommended for treatment, and surgical procedures may become necessary.
Jung
N
N
Department I of Internal Medicine, University of Cologne, 50935 Cologne, Germany. norma.jung@uni-koeln.de
Lehmann
C
C
Hellmann
M
M
Seifert
H
H
Valter
M M
MM
Hallek
M
M
Fätkenheuer
G
G
Kochanek
M
M
D018784:Abdominal Abscess / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D001427:Bacterial Toxins / Q000096:biosynthesis*; D001472:Bartholin's Glands; D003131:Combined Modality Therapy; D004359:Drug Therapy, Combination; D005098:Exotoxins / Q000096:biosynthesis*; D005260:Female; D006801:Humans; D007121:Immunocompetence; D007956:Leukocidins / Q000096:biosynthesis*; D008169:Lung Abscess / Q000150:complications / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D011023:Pneumonia, Staphylococcal / Q000150:complications* / Q000188:drug therapy / Q000382:microbiology / Q000473:pathology; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification / Q000378:metabolism*; D016896:Treatment Outcome; D055815:Young Adult
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin