Septicaemia in an adolescent presenting with potentially fatal CA MRSA osteomyelitis

Description 

A 14-year-old boy, with no prior medical history, presented with tenderness on the right knee after minor trauma while playing football the previous day. On physical examination, there were minor inflammatory signs, with no penetrating wound and he was sent home.

Two days later, due to worsening symptoms, MRI of the lower limb was performed and revealed multiple tibial lytic lesions, intraosseous abscesses and diffuse soft tissue oedema (figure 1).

Figure 1

Lower limb MRI imaging revealed multiple serpiginous lytic lesions in the proximal tibial metaphyseal region suggesting intraosseous abscesses.

Surgical debridement was performed and flucloxacillin and amikacin were initiated. The following day, his clinical status deteriorated with septic shock and respiratory failure. He was admitted in the paediatric intensive care unit.

Preoperatory blood cultures identified a methicillin-resistant Staphylococcus aureus (MRSA) Panton-Valentine leucocidin (PVL) positive and antimicrobial therapy was...

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