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Spontaneous community-acquired PVL-producing Staphylococcus aureus mediastinitis in an immunocompetent adult – a case report

Abstract : Background: Mediastinitis caused by hematogenous spread of an infection is rare. We report the first known case of community-acquired mediastinitis from hematogenous origin in an immunocompetent adult. This rare invasive infection was due to Panton-Valentine Leucocidin-producing (PVL+) methicillin-susceptible Staphylococcus aureus (MSSA). Case presentation: A 22-year-old obese man without other medical history was hospitalized for febrile precordial chest pain. He reported a cutaneous back abscess 3 weeks before. CT-scan was consistent with mediastinitis and blood cultures grew for a PVL+ MSSA. Intravenous clindamycin (600 mg t.i.d) and cloxacillin (2 g q.i.d.), secondary changed for fosfomycin (4 g q.i.d.) because of a related toxidermia, was administered. Surgical drainage was performed and confirmed the presence of a mediastinal abscess associated with a fistula between the mediastinum and right pleural space. All local bacteriological samples also grew for PVL+ MSSA. In addition to clindamycin, intravenous fosfomycin was switched to trimethoprim-sulfamethoxazole after 4 weeks for a total of 10 weeks of antibiotics. Conclusions: We present the first community-acquired mediastinitis of hematogenous origin with PVL+ MSSA. Clinical evolution was favorable after surgical drainage and 10 weeks of antibiotics. The specific virulence of MSSA PVL+ strains played presumably a key role in this rare invasive clinical presentation.
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Submitted on : Thursday, October 15, 2020 - 4:33:24 PM
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Josselin Brisset, Thomas Daix, Jérémy Tricard, Bruno Evrard, Philippe Vignon, et al.. Spontaneous community-acquired PVL-producing Staphylococcus aureus mediastinitis in an immunocompetent adult – a case report. BMC Infectious Diseases, BioMed Central, 2020, 20 (1), pp.354. ⟨10.1186/s12879-020-05076-6⟩. ⟨inserm-02968366⟩

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