29. National Pediatric Surgery Congress and 27. National Congress of The Egyptian Pediatric Surgical Association

Aim

Community acquired S. aureus infections are increasing worldwide. Community acquired Methicillin-sensitive S. aureus (CA-MSSA) is a rare cause of multifocal, severe disease in otherwise healthy children. An unusual case of CA-MSSA bacteraemia is described.

Case

A four-year-old girl presented with a swollen left thigh and a febrile illness of 24 hours. On admission, she was pyrexial, tachycardic and tachypnoeic with a tender, erythematous left thigh and difference of girth of 4 cms. Laboratoty tests showed elevated WBC, ESR and CRP. Triplex US revealed femoral and popliteal vein thrombosis while US showed quadriceps pyomyositis. The patient was started on Ceftriaxone, Vancomycin and low molecular weight heparine. On diagnostic work up, hypercoagulation profile and abdominal CT was normal; chest CT findings were consistent with multiple septic emboli. Blood culture yielded Methicillin-sensitive S. aureus. Fever persisted for ten days and acute phase reactants remained elevated for forty days. The patient completed a four week course of intravenous Vancomycin and was discharged home on oral antibiotics for another three weeks. On follow up, she was clinically well; triplex US showed resolution of deep vein thrombosis and chest CT confirmed improvement of pulmonary involvement.

Conclusion

Deep vein thrombosis should be considered in children presenting with musculosceletal infections; the association with respiratory symptoms and abnormal pulmonary findings should raise suspicion of multifocal S. aureus disease. This condition is rare, but carries a high mortality; therefore, early recognition and initiation of aggressive treatment may be life saving.

Aim

Community acquired S. aureus infections are increasing worldwide. Community acquired Methicillin-sensitive S. aureus (CA-MSSA) is a rare cause of multifocal, severe disease in otherwise healthy children. An unusual case of CA-MSSA bacteraemia is described.

Case

A four-year-old girl presented with a swollen left thigh and a febrile illness of 24 hours. On admission, she was pyrexial, tachycardic and tachypnoeic with a tender, erythematous left thigh and difference of girth of 4 cms. Laboratoty tests showed elevated WBC, ESR and CRP. Triplex US revealed femoral and popliteal vein thrombosis while US showed quadriceps pyomyositis. The patient was started on Ceftriaxone, Vancomycin and low molecular weight heparine. On diagnostic work up, hypercoagulation profile and abdominal CT was normal; chest CT findings were consistent with multiple septic emboli. Blood culture yielded Methicillin-sensitive S. aureus. Fever persisted for ten days and acute phase reactants remained elevated for forty days. The patient completed a four week course of intravenous Vancomycin and was discharged home on oral antibiotics for another three weeks. On follow up, she was clinically well; triplex US showed resolution of deep vein thrombosis and chest CT confirmed improvement of pulmonary involvement.

Conclusion

Deep vein thrombosis should be considered in children presenting with musculosceletal infections; the association with respiratory symptoms and abnormal pulmonary findings should raise suspicion of multifocal S. aureus disease. This condition is rare, but carries a high mortality; therefore, early recognition and initiation of aggressive treatment may be life saving.