Multifocal community-acquired necrotizing fasciitis caused by a Panton-Valentine leukocidin-producing methicillin-sensitive Staphylococcus aureus.
We describe a rare case of multifocal necrotizing fasciitis (NF) complicating a single vaccine injection. Injection of hepatitis B vaccine of a 16-year-old immunocompetent woman developed into rapidly spreading multifocal NF of the right arm and the thighs, with septic shock. Treatment with antimicrobial therapy and surgical debridements allowed amputation to be avoided with a favourable outcome. The etiological agent was a methicillin-sensitive Staphylococcus aureus (MSSA) isolate harboring the Panton-Valentine leukocidin (PVL) and five enterotoxins. PVL has recently been reported in large series of methicillin-resistant SA cases and has been associated with necrotizing infections. Some strains of MSSA could harbor PVL and enterotoxins. PCR investigation is not frequent but could improve the understanding of the mechanisms of lesions. This case is in keeping with the increasing incidence of MSSA harboring PVL and enterotoxins with multifocal dissemination NF and emphasizes the necessary precautions for skin decontamination before vaccine injection.
Perbet
S
S
General Intensive Care Unit, Cochin Hospital, APHP, Paris, France. perbetseb@hotmail.com
Soummer
A
A
Vinsonneau
C
C
Vandebrouck
A
A
Rackelboom
T
T
Etienne
J
J
Cariou
A
A
Chiche
J-D
JD
Mira
J-P
JP
Charpentier
J
J
D000293:Adolescent; D000900:Anti-Bacterial Agents / Q000494:pharmacology / Q000627:therapeutic use; D001427:Bacterial Toxins / Q000096:biosynthesis* / Q000235:genetics; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D005098:Exotoxins / Q000096:biosynthesis* / Q000235:genetics; D019115:Fasciitis, Necrotizing / Q000188:drug therapy / Q000382:microbiology* / Q000601:surgery; D005260:Female; D006801:Humans; D007956:Leukocidins / Q000096:biosynthesis* / Q000235:genetics; D055624:Methicillin-Resistant Staphylococcus aureus / Q000187:drug effects / Q000235:genetics / Q000302:isolation & purification; D013211:Staphylococcus aureus / Q000187:drug effects / Q000302:isolation & purification* / Q000378:metabolism
D000900:Anti-Bacterial Agents; D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin