Article in Japanese

A case of community-acquired methicillin-resistant Staphylococcus aureus causing intramuscular abscesses and subsequent familial infection

Souichi SHIMAZAKI^1）, Yuji OTO^1）, Shinichiro TANAKA^1）, Yuriha KASAI^2）, Mitsutaka KOMATSU^2）, Tomoyo MATUBARA^1）

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is transmitted mainly through skin contact in healthy children and young athletes. In particular, Panton-Valentine leukocidin (PVL)-producing MRSA is highly pathogenic, can spread by
contact and causes nosocomial and familial infections. A 15-year-old healthy boy was admitted with complaints of lumbar pain, right-sided abdominal pain, and fever. His white blood cell count and C-reactive protein level were high, and computed tomography
showed abscesses in the right internal oblique and right erector spinae muscles. Since the patient’s condition did not improve following intravenous ampicillin/sulbactam infusion, incisional drainage and drain placement of the abscesses were performed in the
right internal oblique and right erector spinae muscles on the fourth day of hospitalization, and the patient’s condition subsequently improved. MRSA was detected in the culture of the abscess fluid, which was a PVL gene-possessing strain. The patient’s father
harbored recurrent subcutaneous abscesses for 7 months prior to his son’s admission. Four months before the patient’s admission, his younger brother (second son) had frequent conjunctivitis and hordeolum. Subcutaneous abscesses also were observed in another younger brother (third son), and the mother as well, after the patient was discharged from hospital. MRSA was detected in nasal and abscess cultures of all the family members, and the PCR-based open-reading frame typing (POT) method revealed that they had the same genotype with POT values of 106-77-113. As a result of treatment administration, all of the family members with antimicrobial agents were provided with lifestyle guidance such as hand disinfection, and no further infections have been observed.

---

1）Department of Pediatrics, Dokkyo Medical University Saitama Medical Center

2）Department of Pediatrics, Juntendo University Faculty of Medicine

Key words	community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA), Panton-Valentine leucocidin (PVL), familial infection, intramuscular abscesses
Received	March 24, 2021
Accepted	July 20, 2021

33 (4)：351─358,2021