title: Necrotizing pneumonia caused by Panton-Valentine leucocidin-producing Staphylococcus aureus originating from a Bartholin's abscess.
abstract: 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.
authors.affiliation: Department I of Internal Medicine, University of Cologne, 50935 Cologne, Germany. norma.jung@uni-koeln.de
authors.forename: N
authors.initials: N
authors.lastname: Jung
authors.forename: C
authors.initials: C
authors.lastname: Lehmann
authors.forename: M
authors.initials: M
authors.lastname: Hellmann
authors.forename: H
authors.initials: H
authors.lastname: Seifert
authors.forename: M M
authors.initials: MM
authors.lastname: Valter
authors.forename: M
authors.initials: M
authors.lastname: Hallek
authors.forename: G
authors.initials: G
authors.lastname: Fätkenheuer
authors.forename: M
authors.initials: M
authors.lastname: Kochanek
mesh_terms: 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
chemical_list: D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin