COVID-19-associated Staphylococcus aureus cavitating pneumon
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A young woman with a background of type 2 diabetes mellitus presented with a 3-day history of shortness of breath and a positive COVID-19 PCR nasopharyngeal swab. She was hypoxic and the chest radiograph revealed bilateral interstitial infiltrates suggestive of COVID-19 pneumonitis.

A CT pulmonary angiogram ruled out pulmonary embolism and showed ground glass changes without cavitations. On day 1 of hospital admission, she was transferred to the intensive care unit (ICU) due to worsening hypoxia, requiring invasive ventilation 3 days later. The blood cultures taken on days 1 and 5 of admission were negative. After initial improvement, on day 9, she became septic, had increased oxygen requirements and a new inflammatory response (procalcitonin rise from 0.18 µg/L to 63.4 µg/L, C reactive protein 39 mg/L.

She was initially treated for a ventilator-associated pneumonia with piperacillin/tazobactam. The chest radiograph on day 9 showed new bilateral cavitating lung lesions. Both blood cultures and endotracheal tube secretions taken on day 10 grew Panton-Valentine leucocidin (PVL)-negative, methicillin-susceptible Staphylococcus aureus (MSSA). The antibiotics were initially switched to flucloxacillin 2 g four times a day, and later, due to ongoing clinical deterioration, clindamycin and empirical voriconazole were added to the regimen. Bronchoalveolar lavage samples confirmed MSSA without evidence of tuberculosis or fungal infection (negative mycology cultures, low galactomannan, negative Aspergillus PCR) and serum fungal infection markers (beta-D-glucan, galactomannan) were also low.

An extensive respiratory viral PCR panel was performed, which did not detect any concurrent viral infection. A transthoracic echocardiogram did not show vegetations. Unfortunately, the patient remained in septic shock despite appropriate antibiotics and maximal supportive therapy and passed away 15 days after admission.

Dr. D●●●●k G●●e and 1 others like this
Dr. S●●●●p N●●h
Dr. S●●●●p N●●h Internal Medicine
Show me the cavity or cavitation in Xray....
Jun 16, 2021Like