Staphylococcus aureus Bacteremia Complicating Herpes Simplex Virus Type 1 Stomatitis: Case Report and Review of the Literature

BACKGROUND: Gingivostomatitis is a common clinical manifestation of primary herpes simplex virus type 1 (HSV-1) infection in children. The most common complication of herpetic gingivostomatitis is dehydration; rarely, it may be complicated by secondary bacteremia, and Kingella kingae and group A Streptococcus infections have been reported to be responsible for such episodes. METHODS: We describe the clinical course of a 4.5-year-old girl several years after a liver transplantation, who presented with high fever, vesicular lesions in the buccal region, and cervical lymphadenopathy. RESULTS: Viral culture from the vesicles grew HSV-1, whereas blood culture and bacterial culture from the vesicles grew methicillin-sensitive Staphylococcus aureus with identical antibiogram. Serology against HSV-1 confirmed a recent infection. The child was treated with cephalexin and improved gradually. CONCLUSIONS: Herpetic lesions of the oral mucosa might serve as a port of entry for pathogens including Staphylococcus aureus. Pediatricians and dentists should be aware of bacterial complications in children with herpetic stomatitis.