Community-Acquired Staphylococcus aureus Pneumonia Accompanied by Rapidly Progressive Glomerulonephritis and Hemophagocytic Syndrome

Abstract

A 59-year-old woman without underlying disease was admitted to a local hospital because of lung abscess, cytopenias and renal failure. 3 days before admission, she was diagnosed as influenza infection and was under antiviral therapy. Blood cultures were positive for methicillin-sensitive Staphylococcus aureus (MSSA). She was transferred to our hospital on the 15th day at the local hospital because the clinical manifestations could not improve even though she was treated with multiple intravenous antibiotics directed against MSSA. Sputum cultures yielded methicillin-resistant S. aureus (MRSA) producing toxic shock syndrome toxin-1 (TSST-1) and serologic test indicated hypercytokinemia. She was diagnosed as rapidly progressive glomerulonephritis and hemophagocytic syndrome associated with staphylococcal infection. The pulmonary lesions, cytopenias and renal dysfunction improved as a result of long-term antimicrobial treatment including vancomycin, hemodialysis, short-term administration of corticosteroid and other supportive cares. She was finally weaned from hemodialysis on the 73rd hospital day. In recent years, the number of cases of S. aureus producing TSST-1 and enterotoxin has been increasing and in cases of staphylococcal infections, close attention should be given to toxin-mediated as well as non-toxin-mediated clinical manifestations.

Macrophage activation syndrome associated with co-trimoxazole

“…All three patients had a good outcome. The delay between the introduction of co-trimoxazole and the onset of MAS was nine to 10 days [9], compatible with our case (12 days) and longer than MAS induced by bacterial infections [4][5][6][7]. Vancomycin is the only other antibiotic associated with MAS, with five reported cases [9,10], often associated with a drug hyper sensibility syndrome [8][9][10] with a similar delay before onset (between four and 10 days) [10].…”

“…The clinical presentation of MAS secondary to bacterial infections is almost always associated with severe sepsis or septic shock [2][3][4][5][6][7]; this was not the case for our patient whose osteitis outcome was good. Moreover, the reported cases of MAS induced by pyogenic bacteria, especially Staphylococcus aureus, usually occurred 8 days (5-15 days) after the onset of infection [4][5][6][7], whereas for our patient, MAS occurred 24 days after the onset of infection. MAS secondary to bacterial infection has a poor prognosis without a specific treatment such as steroid or immunosuppressive drugs [1,2], with a mortality rate superior to 49 % [1].…”

Lung abscess caused by Mycoplasma pneumoniae

“…Third, radiology on admission already indicated the lung abscess. Finally, the patient developed cytokine storm, which is not uncommon during mycoplasma infection, but extremely rare during staphylococcal infection . Therefore, one can conclude that the lung abscess in the present case was caused by M .…”

Toxic shock syndrome due to community-acquired methicillin-resistant Staphylococcus aureus infection: Two case reports and a literature review in Japan

“…Based on our search of Medline and Igaku Chuo Zasshi (a tool for searching Japanese biomedical publications), no case series or controlled studies were identified. We could identify 8 cases (3 male and 5 female); 4 case reports were written in English, and 4 were written in Japanese and had been cited by both Japanese and English studies (age range: 16–77 years; median age: 44 years) (Table 1) [11], [12], [13], [14], [15], [16], [17], [18]. Among these cases, skin and soft tissue infections and necrotizing pneumonia were the main portal of entry.…”