Catastrophic complications of PVL-MRSA necrotizing pneumonia presenting as respiratory failure and rhabdomyolysis, case report and review of the literature

Panton-Valentine leucocidin toxin-producing methicillin-resistant staphylococcus aureus is an important uncommon cause of community-acquired pneumonia; we describe a case of necrotizing pneumonia presenting as respiratory failure necessitating early initiation of extracorporeal membrane oxygenation, acute kidney injury and rhabdomyolysis, awareness, prompt recognition and appropriate management are crucial due to possible significant pathology.

Methicillin resistant staphylococcus aureus thoracic spondylitis late after cervical spine surgery

BACKGROUND

Spondylodiscitis is a known and serious complication of spinal surgery. A rare case of a late and remote thoracis spondrylitis due to methicillin resistant staphylococcus aureus following cervical surgery is presented.

CASE REPORT

A 50 year-old-male was treated for cervical degenerative disease via a combined anterior and posterior cervical approach (discectomy with fusion and laminectomy). Three years later a cervical epidural abscess was formed which was treated successfully conservatively. After 18 months he developed spondylitis of the second thoracic vertebra. The patient was further treated surgically via a dorsolateral extracavitary thoracic approach. Laboratory analysis revealed Methicillin Resistant Staphylococcus Aureus (MRSA) spondylitis sensitive to linezolid. Inflammation markers declined and clinical symptoms ameliorated. At 12-month follow-up the patient did not show any evidence of recurrence of the infection.

CONCLUSIONS

A high rate of suspicion must be maintained in patients presenting with signs of spinal infection and neurological impairment even many years after the initial operation. Optimal investigation and outcome require close clinical monitoring and a well coordinated multidisciplinary approach.