Multifocal community-acquired necrotizing fasciitis caused by a Panton-Valentine leukocidin-producing methicillin-sensitive Staphylococcus aureus

Infection. 2010 Jun;38(3):223-5. doi: 10.1007/s15010-010-0002-7. Epub 2010 Mar 17.

Abstract

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.

Publication types

  • Case Reports

MeSH terms

  • Adolescent
  • Anti-Bacterial Agents / pharmacology
  • Anti-Bacterial Agents / therapeutic use
  • Bacterial Toxins / biosynthesis*
  • Bacterial Toxins / genetics
  • Community-Acquired Infections / drug therapy
  • Community-Acquired Infections / microbiology*
  • Community-Acquired Infections / surgery
  • Exotoxins / biosynthesis*
  • Exotoxins / genetics
  • Fasciitis, Necrotizing / drug therapy
  • Fasciitis, Necrotizing / microbiology*
  • Fasciitis, Necrotizing / surgery
  • Female
  • Humans
  • Leukocidins / biosynthesis*
  • Leukocidins / genetics
  • Methicillin-Resistant Staphylococcus aureus / drug effects
  • Methicillin-Resistant Staphylococcus aureus / genetics
  • Methicillin-Resistant Staphylococcus aureus / isolation & purification
  • Staphylococcus aureus / drug effects
  • Staphylococcus aureus / isolation & purification*
  • Staphylococcus aureus / metabolism

Substances

  • Anti-Bacterial Agents
  • Bacterial Toxins
  • Exotoxins
  • Leukocidins
  • Panton-Valentine leukocidin