Complicated Pneumonia and Septicemia due to Community-acquired Staphylococcus sciuri Infection in an Immunocompetent Adolescent
Neha Joshi, Preeti Deswal, Puja Bahl, Vrushali PatwardhanAbstract
Background:
Coagulase-negative staphylococci (CONS) are increasingly being recognized as significant pathogens.
Clinical Description:
A healthy 15-year-old boy presented with high-grade fever, pleuritic chest pain, and progressive lower-lip edema with discoloration. On examination, he was febrile with tachypnea and a violaceous rash over the lip; he was normotensive without pallor. There was decreased bilateral air entry in the chest, without adventitious sounds.
Management and Outcome:
Initial investigations showed thrombocytopenia, raised hematocrit, transaminitis, and elevated C-reactive protein. Despite supportive care and adequate antimicrobial therapy, he developed worsening cellulitis, bilateral suppurative pleural effusions, and necrotizing pneumonia. Blood culture grew MRSS sensitive to teicoplanin. Contact with stray dogs suggested a possible zoonotic source. Even with culture-guided therapy, the clinical condition deteriorated, and computed tomography of the chest (day 9) revealed bilateral loculated effusions and cavitary nodules. Pleural fluid culture also reconfirmed MRSS resistant to all β-lactams. Finally, ceftaroline was initiated, and patient showed remarkable improvement within 96 h. Ceftaroline was continued for 14 days, followed by oral linezolid for 4 weeks. At 6-week follow-up, radiology and spirometry confirmed resolution.
Conclusion:
This case highlights one of the first pediatric reports of community-acquired MRSS septicemia with cellulitis, necrotizing pneumonia, and empyema in an immunocompetent adolescent. It further depicts successful salvage with ceftaroline, highlighting its potential in refractory CoNS/MRS-spectrum.