Back pain in a previously healthy teenager

Abstract

SUMMARYWe present the case of a 14-year-old previously healthy boy who presented to his general practitioner with back pain and fever after rugby training. He was initially treated for suspected discitis but during the course of his admission he rapidly deteriorated and developed severe necrotising pneumonia. He was intubated, ventilated and transferred to a paediatric intensive care unit. Panton-Valentine leukocidin Staphylococcus aureus was suspected and subsequently identified in blood cultures. BACKGROUND

Panton-valentine leukocidin Staphylococcus aureus severe infection in an infant: a case report and a review of the literature

“…Since 2010, we have identified 15 reported cases of paediatric PVL-SA severe infections and Table 1 summarizes the main results of these reports regarding the clinical presentations, radiological findings, treatment and outcome [2][3][4][5][15][16][17][18][19][20][21][22][23].…”

“…Redness of left foot. Large osteomyelitis of left tibia with intramedullary abscesses and significant edema of surrounding muscles (MRI) Intravenous flucloxacillin and gentamicin MRSA genotype not clarified Four weeks of intravenous antibiotics, follow by 4 weeks of oral antibiotic (not clarified) Recurrent surgical drainage (5 times) Sever restriction of the motion the left ankle Haider, 2013, United Kingdom [ 3 ] 1 12-years, M Sore throat, fever, haemoptysis, progressive respiratory failure Extensive bilateral alveolar pulmonary shadowing (chest X-ray) Intravenous cefuroxime Not clarified if MSSA or MRSA Not clarified No surgical treatment Death Fitzgerald, 2013, United Kingdom [ 17 ] 1 14-years, M Fever, back pain (after rugby training), follow by severe necrotizing pneumonia Discitis and peridural abscess at L3-L4 (MRI). Bilateral interstitial infiltrates (chest X-ray) Intravenous flucloxacillin and clindamycin, followed by ceftriaxone, clindamycin, clarithromycin and linezolid MSSA genotype not clarified After 7 days he was treated with intravenous ceftriaxone and oral clindamycin for 3 months No surgical treatment.…”

“…Generally, a long duration antibiotic therapy is usually needed, in particular in complicated cases [ 17 ]. Unfortunately, antibiotic treatment alone is often insufficient, as antibiotic distribution is reduced in necrotic tissue.…”