Abstract
We describe a rare case of multifocal necrotizing fasciitis (NF) complicating a single vaccine injection. Injection of hepatitis B vaccine of a 16-year-old immunocompetent woman developed into rapidly spreading multifocal NF of the right arm and the thighs, with septic shock. Treatment with antimicrobial therapy and surgical debridements allowed amputation to be avoided with a favourable outcome. The etiological agent was a methicillin-sensitive Staphylococcus aureus (MSSA) isolate harboring the Panton-Valentine leukocidin (PVL) and five enterotoxins. PVL has recently been reported in large series of methicillin-resistant SA cases and has been associated with necrotizing infections. Some strains of MSSA could harbor PVL and enterotoxins. PCR investigation is not frequent but could improve the understanding of the mechanisms of lesions. This case is in keeping with the increasing incidence of MSSA harboring PVL and enterotoxins with multifocal dissemination NF and emphasizes the necessary precautions for skin decontamination before vaccine injection.
This is a preview of subscription content, log in via an institution to check access.
Similar content being viewed by others
References
Musher DM, Lamm N, Darouiche RO, Young EJ, Hamill RJ, Landon GC. The current spectrum of Staphylococcus aureus infection in a tertiary care hospital. Medicine (Baltimore). 1994;73:186–208.
Lee YT, Chou TD, Peng MY, Chang FY. Rapidly progressive necrotizing fasciitis caused by Staphylococcus aureus. J Microbiol Immunol Infect. 2005;38:361–4.
Wong CH, Tan SH, Kurup A, Tan AB. Recurrent necrotizing fasciitis caused by methicillin-resistant Staphylococcus aureus. Eur J Clin Microbiol Infect Dis. 2004;23:909–11.
Miller LG, Perdreau-Remington F, Rieg G, et al. Necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus in Los Angeles. N Engl J Med. 2005;352:1445–53.
Moran GJ, Krishnadasan A, Gorwitz RJ, Fosheim GE, McDougal LK, Carey RB, et al. EMERGEncy ID net study group. Methicillin-resistant S. aureus infections among patients in the emergency department. N Engl J Med. 2006;355:666–74.
Gillet Y, Issartel B, Vanhems P, Fournet JC, Lina G, Bes M, et al. Association between Staphylococcus aureus strains carrying gene for Panton-Valentine leukocidin and highly lethal necrotising pneumonia in young immunocompetent patients. Lancet. 2002;359:753–9.
Morgan WR, Caldwell MD, Brady JM, Stemper ME, Reed KD, Shukla SK. Necrotizing fasciitis due to a methicillin-sensitive Staphylococcus aureus isolate harboring an enterotoxin gene cluster. J Clin Microbiol. 2007;45:668–71.
Gerard D, Mariani-Kurkdjian P, Sachs P, Berrebi D, Van-Den-Abbeele T, Dauger S. Facial necrotizing fasciitis in an infant caused by a five toxin-secreting methicillin-susceptible Staphylococcus aureus. Intensive Care Med. 2009;35:1145–6.
Lehman D, Tseng CW, Eells S, Miller LG, Fan X, Beenhouwer DO, et al. Staphylococcus aureus Panton-Valentine leukocidin targets muscle tissues in a child with myositis and necrotizing fasciitis. Clin Infect Dis. 2010;50:69–72.
Schlievert PM, Kelly JA. Clindamycin-induced suppression of toxic-shock syndrome–associated exotoxin production. J Infect Dis. 1984;149:471.
de Bentzmann S, Tristan A, Etienne J, Brousse N, Vandenesch F, Lina G. Staphylococcus aureus isolates associated with necrotizing pneumonia bind to basement membrane type I and IV collagens and laminin. J Infect Dis. 2004;190:1506–15.
Conflict of interest statement
None.
Author information
Authors and Affiliations
Corresponding author
Rights and permissions
About this article
Cite this article
Perbet, S., Soummer, A., Vinsonneau, C. et al. Multifocal community-acquired necrotizing fasciitis caused by a Panton-Valentine leukocidin-producing methicillin-sensitive Staphylococcus aureus . Infection 38, 223–225 (2010). https://doi.org/10.1007/s15010-010-0002-7
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s15010-010-0002-7