Marlene Rodrigues

Septicaemia in an adolescent presenting with potentially fatal CA MRSA osteomyelitis

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 …

VURD syndrome in an infant presenting with potentially fatal staphylococcal urinary tract infection and septicaemia

A newborn (NB) boy was delivered at 39 weeks of gestation with 4160 g weight and an APGAR score of 8/9. The pregnancy was uneventful, with normal first and second trimester ultrasound. The third trimester ultrasound revealed an isolated right kidney hydronephrosis, a normal sized bladder without thickening of wall as well a normal amniotic fluid volume. Kidney and bladder ultrasound (KBU) scan performed 48 hours after birth showed persistence of right kidney hydronephrosis as well dilation of right ureter. The left kidney and ureter were normal and alteration in bladder volume, bladder wall thickness and posterior urethra were observed. Trimethoprim prophylaxis was started, and the NB was discharged home in good condition. At 1 month age he was revaluated and remained asymptomatic, with an appropriate weight gain. The parents reported normal micturition with good urinary stream, without straining or dribbling. No changes were found on physical examination and the bladder was not palpable. In the second month of life the infant was admitted to the …