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TWO CASES OF PANTON-VALENTINE LEUKOCIDIN (PVL) TOXIN POSITIVE STAPHYLOCOCCUS AUREUS (MSSA) OSTEOMYELITIS IN CHILDREN.

Southampton Hospitals NHS Trust

Aim: To present the features of PVL toxin positive staphylococcus causing osteomyelitis in children and its management.

Method: Two cases of PVL MSSA osteomyelitis have presented to our institute within the last six months. The first, a 15 year old boy presented with an abscess and surrounding cellulitis on the lower right leg following a skin abrasion sustained whilst playing football. He was recognized as being systemically unwell with extremely elevated inflammatory markers. Radiographic investigations demonstrated osteomyelitis.

The second case was that of an 11 year old girl who developed cellulitis of the lower thigh, but was not as systemically unwell as the first case. Radiographs again demonstrated osteomyelitis.

Results: Both children were treated with intravenous antibiotics and supportive measures and made a full recovery.

Conclusions: Panton Valentine Leukocidin (PVL) is a toxic substance produced by some strains of Staphylococcus aureus with an increased ability to cause disease. Although more common in the United States, less than 2% of all S. aureus infections in the UK carry the toxin. PVL can be carried both by MRSA (methicillin resistant) and MSSA (methicillin sensitive) Staphylococcus aureus.

Patients normally present with cellulitis, abscesses, boils and carbuncles. However, on rare occasions, more severe invasive infections result, including septic arthritis, bacteraemia or necrotizing pneumonia.

We feel that osteomyelitis caused by PVL positive MSSA is associated with more severe local disease and a greater systemic inflammatory response than osteomyelitis caused by PVL negative MSSA. Treatment is effective but needs to be initiated promptly to prevent significant complications.

Correspondence should be addressed to: Mr J. B. Hunter, BSCOS, c/o BOA, The Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PE.