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Case Reports
. 2020 May 19;20(1):354.
doi: 10.1186/s12879-020-05076-6.

Spontaneous community-acquired PVL-producing Staphylococcus aureus mediastinitis in an immunocompetent adult - a case report

Josselin Brisset  1   2 , Thomas Daix  3   4 , Jérémy Tricard  5 , Bruno Evrard  1 , Philippe Vignon  1   6 , Olivier Barraud  6   7 , Bruno François  1   6
Affiliations
Case Reports

Spontaneous community-acquired PVL-producing Staphylococcus aureus mediastinitis in an immunocompetent adult - a case report

Josselin Brisset et al. BMC Infect Dis. .

Abstract

Background: Mediastinitis caused by hematogenous spread of an infection is rare. We report the first known case of community-acquired mediastinitis from hematogenous origin in an immunocompetent adult. This rare invasive infection was due to Panton-Valentine Leucocidin-producing (PVL+) methicillin-susceptible Staphylococcus aureus (MSSA).

Case presentation: A 22-year-old obese man without other medical history was hospitalized for febrile precordial chest pain. He reported a cutaneous back abscess 3 weeks before. CT-scan was consistent with mediastinitis and blood cultures grew for a PVL+ MSSA. Intravenous clindamycin (600 mg t.i.d) and cloxacillin (2 g q.i.d.), secondary changed for fosfomycin (4 g q.i.d.) because of a related toxidermia, was administered. Surgical drainage was performed and confirmed the presence of a mediastinal abscess associated with a fistula between the mediastinum and right pleural space. All local bacteriological samples also grew for PVL+ MSSA. In addition to clindamycin, intravenous fosfomycin was switched to trimethoprim-sulfamethoxazole after 4 weeks for a total of 10 weeks of antibiotics.

Conclusions: We present the first community-acquired mediastinitis of hematogenous origin with PVL+ MSSA. Clinical evolution was favorable after surgical drainage and 10 weeks of antibiotics. The specific virulence of MSSA PVL+ strains played presumably a key role in this rare invasive clinical presentation.

Keywords: Community-acquired mediastinitis; MSSA; Panton-valentine Leucocidin.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Chest CT scan of the initial presentation of the mediastinitis, with diffuse mediastinal infiltration
Fig. 2
Fig. 2
This picture taken during surgery, evidenced the fistula (white arrow) from the mediastinum to the right pleura
Fig. 3
Fig. 3
(a) Day 7 CT scan- acme of the mediastinal infiltration, with abscesses formation (3 days after surgery); (b) CT scan at M1 after intensive care unit admission; (c) CT scan at M2 after intensive care unit admission
See this image and copyright information in PMC

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