Successful treatment of panton-valentine leukocidin-expressing staphylococcus aureus-Associated pneumonia co-infected with influenza using extracorporeal membrane oxygenation

Noritomo Fujisaki, Azusa Takahashi, Takahiro Arima, Tomoya Mizushima, Katsuki Ikeda, Hiroyuki Kakuchi, Atsunori Nakao, Joji Kotani, Koji Sakaida

Research output: Contribution to journalArticle

6 Citations (Scopus)

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 lifethreatening PVL-expressing S. aureus-Associated pneumonia who was rescued using extracorporeal membrane oxygenation (ECMO). Case Report: 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-yearold 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 3.5×103/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. Conclusion: 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.

Original languageEnglish
Pages (from-to)961-966
Number of pages6
JournalIn Vivo
Volume28
Issue number5
Publication statusPublished - Sep 1 2014
Externally publishedYes

Keywords

  • Influenza
  • Leukocyte destruction
  • Lung necrosis
  • Membrane oxygenation
  • PVL
  • Panton-Valentine leukocidin
  • Pneumonia
  • Staphylococcus aureus

ASJC Scopus subject areas

  • Biochemistry, Genetics and Molecular Biology(all)
  • Pharmacology

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