Destructive pulmonary embolism in a patient with community-acquired staphylococcal bacteremia

• Published in: Journal of infection and chemotherapy : official journal of the Japan Society of Chemotherapy Vol. 8; no. 1; pp. 99 - 102
• Main Authors: Miyashita, Taku, Shimamoto, Yuko, Nishiya, Hajime, Koshibu, Yoji, Sugiyama, Hajime, Satoh, Takayoshi, Haraoka, Hitomi, Nakano, Junichi, Ohta, Ken, Sato, Tomohide, Ono, Yasuo, Morinaga, Naoko, Noda, Masatoshi
• Format: Journal Article
• Language: English
• Published: Tokyo Elsevier Ltd 01.03.2002; Springer
• Subjects: Acute pneumonia; Adolescent; Bacteremia - complications; Bacterial diseases; Bacterial sepsis; Bacterial Toxins; Biological and medical sciences; Community-Acquired Infections - complications; Enterotoxins - toxicity; Exotoxins; Human bacterial diseases; Humans; Infectious diseases; Leukocidins - biosynthesis; Leukocidins - genetics; Male; Medical sciences; Panton-Valentine leukocidine; Pneumology; Pulmonary embolism; Pulmonary Embolism - etiology; Pulmonary hypertension. Acute cor pulmonale. Pulmonary embolism. Pulmonary vascular diseases; Staphylococcal Infections - complications; Staphylococcus aureus; Superantigens; Pulmonary embolism; Acute pneumonia; Panton-Valentine leukocidine; Staphylococcus aureus; Human; Lung disease; Pneumonia; Respiratory disease; Cardiovascular disease; Bacteremia; Infection; Vascular disease; Case study; Community acquired infection; Bacteriosis; Bacteria; Micrococcales; Complication; Micrococcaceae; Staphylococcal infection
• ISSN: 1341-321X; 1437-7780
• DOI: 10.1007/s101560200014

We report a 17-year-old man with destructive pulmonary embolism caused by Staphylococcus aureus bacteremia. The patient was not immunocompromised and had neither underlying diseases nor risk factors, such as concomitant influenza viral infection, which exacerbate staphylococcal infections. The rapid and extensive progression of pulmonary involvement in all lung fields make this a rare case; there have been few reports in the literature describing a similar radiographic appearance in patients with community-acquired staphylococcal bacteremia. In-vitro studies did not demonstrate the production of enterotoxins or toxic shock syndrome toxin 1 (TSST-1) by the isolated strain, but genetic analysis detected Panton-Valentine leukocidine gene from the strain. Subsequent empyema with bilateral pneumothorax was prolonged because of superinfection with both methicillin-resistant Staphylococcus aureus and Pseudomonas aeruginosa. Optional surgical treatments, including thoracostomy and thoracopneumoplasty, finally improved his condition.