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Multifocal community-acquired necrotizing fasciitis caused by a Panton-Valentine leukocidin-producing

S Perbet1, A Soummer, C Vinsonneau

  • 1General Intensive Care Unit, Cochin Hospital, APHP, Paris, France. perbetseb@hotmail.com

Infection
|March 19, 2010
PubMed

Insights

A rare case of multifocal necrotizing fasciitis (NF) developed after a hepatitis B vaccine in an immunocompetent teen. The infection, caused by Staphylococcus aureus with Panton-Valentine leukocidin, was successfully treated, avoiding amputation.

Area of Science:

  • Infectious Diseases
  • Dermatology
  • Vaccinology

Background:

  • Necrotizing fasciitis (NF) is a severe soft tissue infection.
  • While often associated with specific bacterial strains, rare complications following vaccinations are documented.
  • Methicillin-sensitive Staphylococcus aureus (MSSA) strains harboring virulence factors like Panton-Valentine leukocidin (PVL) are increasingly recognized.

Observation:

  • A 16-year-old immunocompetent female developed rapidly spreading multifocal NF in her right arm and thighs post-hepatitis B vaccination.
  • The patient presented with septic shock, indicating a severe systemic response.
  • The etiological agent identified was MSSA harboring PVL and five enterotoxins.

Findings:

  • Successful management of multifocal NF and septic shock was achieved with antimicrobial therapy and surgical debridements.
  • Amputation was avoided, leading to a favorable patient outcome.
  • The MSSA isolate possessed both PVL and enterotoxin genes, highlighting potential virulence in non-resistant strains.

Implications:

  • This case underscores the potential for severe bacterial infections, even from MSSA strains, following seemingly routine procedures like vaccine injections.
  • Emphasizes the importance of meticulous skin disinfection prior to vaccination to mitigate infection risks.
  • Suggests that PCR investigation could enhance understanding of the mechanisms behind PVL-associated necrotizing infections.

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