S Lavoue1, G Le Gac1, A Gacouin2, M Revest2, L Sohier3, J Mouline4, S Jouneau5, E Flecher6, P Tattevin2, J-M Tadié7. 1. Service des maladies infectieuses et réanimation médicale, CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France. 2. Service des maladies infectieuses et réanimation médicale, CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; Inserm-CIC-1414, faculté de médecine, université Rennes I, IFRI 40, 35033 Rennes, France. 3. Service de pneumologie, centre hospitalier Lorient, 56322 Lorient, France. 4. Service de réanimation, centre hospitalier Lorient, 56322 Lorient, France. 5. Service de pneumologie, CHU de Rennes, hôpital Pontchaillou, 35033 Rennes, France. 6. Département de chirurgie thoracique et cardiovasculaire, CHU de Rennes, hôpital Pontchaillou, 35033 Rennes, France. 7. Service des maladies infectieuses et réanimation médicale, CHU de Rennes, hôpital Pontchaillou, 2, rue Henri-Le-Guilloux, 35033 Rennes cedex 9, France; Inserm-CIC-1414, faculté de médecine, université Rennes I, IFRI 40, 35033 Rennes, France. Electronic address: jean-marc.tadie@chu-rennes.fr.
Abstract
OBJECTIVE: To describe two cases of Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) necrotizing pneumonia treated with ECMO, and complete pulmonary evaluation at six months. METHODS: Retrospective analysis of two patients presenting with severe PVL-SA pneumonia who both underwent complete respiratory function testing and chest CT scan six months after hospital discharge. RESULTS: Indications for ECMO were refractory hypoxia and left ventricular dysfunction associated with right ventricular dilatation. Patients were weaned off ECMO after 52 and 5 days. No ECMO-related hemorrhagic complication was observed. Pulmonary function tests performed at six months were normal and the CT scan showed complete regression of pulmonary injuries. CONCLUSION: PVL-SA pneumonia is characterized by extensive parenchymal injuries, including necrotic and hemorrhagic complications. ECMO may be used as a salvage treatment without any associated hemorrhagic complication, provided anticoagulant therapy is carefully monitored, and may lead to complete pulmonary recovery at six months.
OBJECTIVE: To describe two cases of Panton-Valentine leukocidin-producing Staphylococcus aureus (PVL-SA) necrotizing pneumonia treated with ECMO, and complete pulmonary evaluation at six months. METHODS: Retrospective analysis of two patients presenting with severe PVL-SA pneumonia who both underwent complete respiratory function testing and chest CT scan six months after hospital discharge. RESULTS: Indications for ECMO were refractory hypoxia and left ventricular dysfunction associated with right ventricular dilatation. Patients were weaned off ECMO after 52 and 5 days. No ECMO-related hemorrhagic complication was observed. Pulmonary function tests performed at six months were normal and the CT scan showed complete regression of pulmonary injuries. CONCLUSION: PVL-SA pneumonia is characterized by extensive parenchymal injuries, including necrotic and hemorrhagic complications. ECMO may be used as a salvage treatment without any associated hemorrhagic complication, provided anticoagulant therapy is carefully monitored, and may lead to complete pulmonary recovery at six months.