A case of rapidly progressive necrotizing pneumonia caused by community-acquired methicillin-resistant Staphylococcus aureus

We present the case of a patient with a necrotizing multilobar pneumonia caused by community-acquired methicillin-resistant Staphylococcus aureus (MRSA). The patient presented with shortness of breath and a productive cough of 3 days duration. On arrival to the emergency department she was intubated for increased work of breathing and given vasopressors for hypotension refractory to fluid resuscitation. Blood cultures taken at admission, sputum cultures from the patient's endotracheal tube, and bronchoalveolar lavage cultures all grew S. aureus resistant to penicillinase-resistant penicillins. Over the following days the patient's respiratory function deteriorated as she grew progressively hypoxemic and hypercarbic despite aggressive mechanical ventilation and intravenous antibiotics. On day 4 of her hospitalization a computed tomogram revealed extensive pulmonary necrosis consistent with necrotizing pneumonia. The patient's family elected to withdraw support, and the patient rapidly died following cessation of mechanical ventilation.