A52-25 Fulminant Panton-Valentine Leukocidin - Positive Staphylococcus Aureus Pneumonia Requiring Ecmo Support

Introduction Panton-Valentine leukocidin (PVL) is a potent cytotoxin produced by certain strains of Staphylococcus aureus (SA), associated with severe skin, soft tissue, and invasive infections in otherwise healthy individuals. Young adults and children with minimal prior healthcare exposure are at highest risk, and PVL-SA can cause rapidly progressive, necrotizing pneumonia and bacteremia with high morbidity and mortality. Early recognition and prompt initiation of anti-toxin antibiotics are critical for optimal outcomes. Case Presentation A previously healthy, unvaccinated young female presented with acute onset of profound hypoxia, tachycardia, and hypotension. She rapidly progressed to respiratory failure and shock, requiring emergent veno-venous extracorporeal membrane oxygenation (VV ECMO) cannulation. Despite maximal supportive care, persistent hemodynamic decompensation necessitated consideration for upgrade to veno-arterial ECMO.Laboratory evaluation revealed leukopenia and elevated inflammatory markers. Blood and respiratory cultures grew Staphylococcus aureus, confirmed by PCR to harbor the PVL gene. Imaging demonstrated multifocal pulmonary infiltrates consistent with necrotizing pneumonia. The patient developed disseminated bacteremia and rapid hemodynamic compromise causing death within 48 hours of presentation. Discussion PVL-SA infections are characterized by aggressive tissue destruction and rapid clinical deterioration, particularly in young, immunocompetent hosts. Necrotizing pneumonia is a hallmark, often preceded by influenza-like symptoms, and associated with hemoptysis, leukopenia, and high fever. Multifocal infections and bacteremia are common, with high rates of respiratory failure and septic shock.Empiric therapy should include MRSA-active agents and antibiotics that inhibit exotoxin production, such as linezolid or clindamycin, in addition to broad-spectrum coverage. Early molecular diagnosis of PVL is essential for guiding therapy and infection control. Advanced supportive measures, including ECMO, may be required in refractory cases.This case underscores the importance of recognizing PVL-SA as a cause of severe, rapidly progressive pneumonia and bacteremia in young, unvaccinated patients. Early diagnosis and aggressive management, including anti-toxin antibiotics and advanced supportive care, are essential to improve outcomes.