Title : Community-associated invasive infection by methicillin-resistant Staphylococcus aureus in an immunocompetent adolescent – case report
Abstract:
Community-associated methicillin-resistant Staphylococcus aureus infection is a rare condition, with pneumonia being an uncommon manifestation, especially in previously healthy individuals. A 13-year-old male patient with no previous medical history was admitted to an infectious disease hospital with severe pain in his groin, thigh, and left calf, which was tight, continuous, aggravated by walking, and relieved by rest. He reported that the complaint began five days earlier after sports activity. After two days, it progressed with uncontrollable vomiting, the appearance of a rash on the lower limbs, jaundice in the extremities, fever (38°C), pleuritic pain, and tachypnea. Non-contrast tomography showed hepatomegaly and diffuse bilateral reticulonodular infiltrate. Treatment was started with Ceftriaxone, later escalated to Piperacillin with Tazobactam and Vancomycin, and cultures were requested. Admission laboratory tests revealed pancytopenia, renal dysfunction, and a significant increase in inflammatory tests. Serology for human immunodeficiency virus, syphilis, Hepatitis B, and Hepatitis C were non-reactive. Five hours after admission, he developed acute respiratory failure and septic shock, likely of pulmonary origin. Fifteen hours after admission to the intensive care unit, he became refractory to treatment, went into asystolic cardiac arrest, and died. He was referred to the death verification service, and the death certificate was issued with a diagnosis of septic shock and bacterial pneumonia. The four blood culture samples collected on admission showed growth of methicillin/oxacillin-resistant Staphylococcus aureus, confirming severe community-acquired invasive infection by a multidrug-resistant microorganism in a previously healthy patient.
