PMC4706898_01
Computed tomography scan of the lungs without contrast showing necrotizing pneumonia with multiple nodules and pleural effusion on admission.
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A computed tomography (CT) scan of the lungs without contrast on admission showed necrotizing pneumonia with multiple nodules and pleural effusion (Figure 1).
Clinical course of a 23-month-old Japanese girl with meningitis, osteomyelitis, fasciitis, necrotizing pneumonia, urinary tract infection, and sepsis due to community-acquired methicillin-resistant Staphylococcus aureus. UTI, urinary tract infection; PCT, procalcitonin; VCM, vancomycin (55 mg/kg/day); LZD, linezolid (30 mg/kg/day); CTX, cefotaxime (100 mg/kg/day); MEPM, meropenem (120 mg/kg/day).
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CSF analysis was performed again and showed a white cell count of 13,603 cells with 914 polymorphonuclear cells/mL, a total protein level of 0.87 g/dL, and a glucose concentration of 50.3 mg/mL (Figure 2).
Gallium-67 citrate scintigraphy showing isolated uptake of the right femur (a) and magnetic resonance imaging scans of the right femur showing osteomyelitis with necrotizing fasciitis (T2-weighted image). There are signal changes in the diaphyseal region of the femurs with circumferential soft tissue involvement (b).
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After 3 days of gradual clinical improvement, a gallium-67 citrate scintigraphy and MRI were performed and both showed osteomyelitis of the right femur with necrotizing fasciitis (Figure 3).