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

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.

Paediatric and adult patients from New Caledonia Island admitted to the ICU for community-acquired Panton-Valentine leucocidin-producing Staphylococcus aureus infections

“…However, these multifocal features were not confirmed in a larger cohort of 16 patients with PVL + Sa pneumonia from the same location 31 . Few case reports have mentioned multiple-site infections or unconventional septic sites, including prostatic or renal abscesses or mediastinitis [32][33][34] .…”

Staphylococcus aureus mediastinitis following a skin infection in a non‑immunocompromised patient: A case report

“…In addition, mediastinitis as a complication of primary skin infections is also a rare entity. Brisset et al ( 1 ) reported a case of Staphylococcus aureus mediastinitis in an immunocompetent adult following back skin abscess. To the best of our knowledge, the present case is the second report of such a case of mediastinitis secondary to hematogenous spread following skin infection.…”

“…Mediastinitis, which is an inflammation of the chest region between the lungs, develops mostly due to a deep wound infection of the sternum, pneumonia, perforation of the esophagus, or descending necrotizing mediastinitis resulting from ear-nose-throat infections ( 1 ). Very rarely, mediastinitis can occur from hematogenous spread, and is usually a complication of the health care received ( 2 ).…”

Unconventional surgery for thoracic esophageal rupture with empyema and mediastinitis: A case report and literature review

“…Mediastinitis is mainly a downward necrotizing mediastinitis caused by deep sternal wound infection, esophageal perforation or ENT infection [2] . Researchers had reported the treatment of thoracic esophageal rupture and with concomitant empyema and mediastinitis [3,4] , but esophagus rupture caused by high pressure gas with concomitant empyema and mediastinitis had never reported.…”