ABSTRACT
We report an unusual case of serious, multifocal, invasive infection due to community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) in a 10-year-old girl with favorable outcome. The child manifested femoral osteomyelitis, pyomyositis, deep femoral vein thrombosis, pneumonia, encephalopathy, and disturbances of almost all organs. She remained in a critical condition for a week. Fever persisted for 6 weeks and acute phase reactants remained increased for 6 months, necessitating a 7-month antistaphylococcal therapy with a glycopeptide and clindamycin. This led to resolution of infection-associated problems during the subsequent 36 months of follow-up. CA-MRSA strain isolated from the patient harbored both staphylococcal chromosomal cassette type IV (SCCmec type IV) and Panton-Valentine leukocidin genes. A literature review of serious CA-MRSA infections indicated that only a small minority of published cases had favorable outcome.
Subject(s)
Methicillin Resistance/immunology , Methicillin-Resistant Staphylococcus aureus/isolation & purification , Staphylococcal Infections/microbiology , Bacterial Proteins/genetics , Bacterial Toxins/genetics , Child , DNA, Bacterial/analysis , Exotoxins/genetics , Female , Follow-Up Studies , Humans , Leukocidins/genetics , Magnetic Resonance Imaging , Methicillin-Resistant Staphylococcus aureus/genetics , Penicillin-Binding Proteins , Polymerase Chain Reaction , Staphylococcal Infections/diagnosis , Staphylococcal Infections/drug therapySubject(s)
Catheters, Indwelling/adverse effects , Dermatomycoses/pathology , Metabolic Diseases/pathology , Zygomycosis/pathology , Amphotericin B/therapeutic use , Anemia, Neonatal/etiology , Anemia, Neonatal/pathology , Anemia, Sideroblastic/etiology , Anemia, Sideroblastic/pathology , Antifungal Agents/therapeutic use , DNA, Mitochondrial , Deferoxamine/therapeutic use , Dermatomycoses/drug therapy , Dermatomycoses/etiology , Female , Hemochromatosis Protein , Heterozygote , Histocompatibility Antigens Class I/genetics , Humans , Infant , Infant, Newborn , Membrane Proteins/genetics , Metabolic Diseases/complications , Metabolic Diseases/drug therapy , Methylprednisolone/therapeutic use , Mitochondrial Diseases/pathology , Siderophores/therapeutic use , Zygomycosis/drug therapy , Zygomycosis/etiologyABSTRACT
BACKGROUND: Pearson syndrome is a rare mitochondrial disorder characterized by sideroblastic anemia, liver disease, renal tubulopathy and exocrine pancreas deficiency. OBSERVATIONS: We describe a female infant suffering from anemia since birth who gradually developed the complete picture of Pearson syndrome by 13 months. Iron overload was disproportionate to blood transfusions. The patient was heterozygous for HFE gene C282Y mutation (type I hemochromatosis). After an initial response to deferoxamine she presented with cutaneous zygomycosis and died after metabolic derangement and Pneumocystis jiroveci pneumonia. CONCLUSION: This is the second case of a Pearson syndrome individual who was also heterozygous for HFE gene mutation C282Y published. It is also the second case report of a Pearson patient suffering from severe iron overload and liver disease that responded to therapy with deferoxamine.
