Necrotizing pneumonia due to Staphylococcus aureus producing Panton-Valentine toxin

Background Necrotizing pneumonia caused by Staphylococcus aureus producing Panton Valentine Leukocidine (PVL) has been described recently and is associated with a high mortality (75%). Observation We report a case of pneumonia due to PV secreting Staphylococcus aureus in a healthy young adult, complicated by multiple necrotizing lung lesions and major cystic changes, with a favourable final outcome. Acute respiratory failure with haemodynamic failure and ARDS developed a few days after an influenza-like illness. The appearances at fibreoptic bronchoscopy were atypical, consisting of a purulent, necrotic tracheobronchitis with desquamation. The initial unfavourable progress despite broad spectrum antibiotic therapy and, finally, the identification of PV leukotoxin in blood cultures and tracheal aspirate, led to the diagnosis. During the clinical course there were repeated pneumothoraces (8 drains) due to multiple bilateral cystic lesions. Ultimately progress was favourable following treatment with antibiotics (flucloxacillin and clindamycin) and steroids. Conclusion It is important to consider pulmonary complications of the Panton-Valentine leukotoxin in a healthy young adult who presents with necrotizing pneumonia and an unfavourable outcome in spite of broad spectrum antibiotics. Treatment is difficult on account of the extent of the necrotizing lesions and the need to use antibiotics effective against both the bacterium and its toxin.