title: Successful treatment of Panton-Valentine leukocidin-expressing Staphylococcus aureus-associated pneumonia co-infected with influenza using extracorporeal membrane oxygenation.
abstract: BACKGROUND
  Panton-Valentine leukocidin (PVL) is a cytotoxin that causes leukocyte destruction and lung necrosis. Managing respiratory failure and acute respiratory distress syndrome secondary to PVL-expressing Staphylococcus aureus pneumonia and its associated lung necrosis with mechanical ventilation is challenging. We report a patient with life-threatening PVL-expressing S. aureus-associated pneumonia who was rescued using extracorporeal membrane oxygenation (ECMO).
  
  
  METHODS
  We examined the case of a woman who presented to our Emergency Department with septic shock due to PVL-expressing S. aureus-associated pneumonia. A 27-year-old Filipino woman was transferred to our hospital due to severe dyspnea, hemosputum, and high-grade fever. She had a medical history of osteosarcoma of the leg and hyperthyroidism. On arrival, her vital signs indicated septic shock, with a white blood cell count of 3.5×10(3)/μl. Because a Gram stain of her sputum indicated SA, therapy with antibiotics, including meropenem and vancomycin, was started. Hypoxemia necessitated intubation and ventilation. Because the patient's PaO2/FiO2 remained less than 60 mmHg and her blood pressure was unstable despite aggressive conventional management, venoarterial ECMO was administered approximately 11 h after her arrival. The ECMO circuit was changed to veno-venous ECMO on day 7 and the patient was successfully weaned off ECMO after 12 days of treatment. She was discharged from the hospital 104 days after admission.
  
  
  CONCLUSIONS
  This case demonstrates that early induction of ECMO support can be a reasonable therapeutic option for PVL-S. aureus-associated pneumonia. This patient's successful outcome might be attributable to early establishment of ECMO to prevent ventilation-induced lung injury.
authors.affiliation: Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan Emergency Department, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Noritomo
authors.initials: N
authors.lastname: Fujisaki
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Azusa
authors.initials: A
authors.lastname: Takahashi
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Arima
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Tomoya
authors.initials: T
authors.lastname: Mizushima
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Katsuki
authors.initials: K
authors.lastname: Ikeda
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Kakuchi
authors.affiliation: Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan qq-nakao@hyo-med.ac.jp.
authors.forename: Atsunori
authors.initials: A
authors.lastname: Nakao
authors.affiliation: Department of Emergency, Disaster and Critical Care Medicine, Hyogo College of Medicine, Nishinomiya, Japan.
authors.forename: Joji
authors.initials: J
authors.lastname: Kotani
authors.affiliation: Emergency Department, Funabashi Municipal Medical Center, Funabashi, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Sakaida
mesh_terms: D000328:Adult; D001427:Bacterial Toxins / Q000235:genetics*; D060085:Coinfection; D005098:Exotoxins / Q000235:genetics*; D015199:Extracorporeal Membrane Oxygenation; D005260:Female; D006801:Humans; D007251:Influenza, Human; D007956:Leukocidins / Q000235:genetics*; D007958:Leukocyte Count; D011023:Pneumonia, Staphylococcal / Q000175:diagnosis / Q000382:microbiology / Q000628:therapy*; D013902:Radiography, Thoracic; D013211:Staphylococcus aureus / Q000235:genetics*; D016896:Treatment Outcome
chemical_list: D001427:Bacterial Toxins; D005098:Exotoxins; D007956:Leukocidins; C078284:Panton-Valentine leukocidin
keywords: PVL; Panton-Valentine leukocidin; Staphylococcus aureus; influenza; leukocyte destruction; lung necrosis; membrane oxygenation; pneumonia