Staphylococcal pneumonia as a complication of cellulitis
More details
Hide details
Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Department of Pulmonology, Faculty of Health Sciences, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Poland
Ewa Mirosława Wygonowska   

Department of Dermatology, Sexually Transmitted Diseases and Clinical Immunology, School of Medicine, Collegium Medicum, University of Warmia and Mazury in Olsztyn, Wojska Polskiego 30, 10-229 Olsztyn, Poland. Tel.: +4889 678 6670.
Submission date: 2020-09-15
Final revision date: 2021-04-12
Acceptance date: 2021-04-13
Online publication date: 2021-07-05
Cellulitis is less common local infection caused by staphylococci but may be accompanied by severe symptoms.

The authors present a case of a 25-year-old woman with cellulitis in the lower jaw area, who had a complication in the form of purulent pneumonia with numerous abscesses and pleurisy.

Case study:
The patient, 25-year-old woman, was admitted to Clinic of Dermatology in Olsztyn due to painful swelling of her cheek, jaw and chin on the right side. The physical examination revealed crackles in the lung base and the chest X-ray image showed numerous circular shadows in the lung fields. In addition, there was fluid in the left pleural cavity. Intensive antibiotic therapy was used in the treatment for 14 days and improvement in the skin lesion was achieved. Cough and radiological changes also subsided.

Results and discussion:
Pneumonia usually develops as a result of the aspiration of the microorganism from the upper respiratory tract or through the bloodstream. Staphylococcal methicillin resistant Staphylococcus aureus (MRSA) infections are a particular problem. Poor hygiene conditions, close contact, contaminated material and damaged skin are some of the risk factors for the spread of MRSA infection in the population of non-hospitalized patients. In this patient, such a predisposing factor was alcohol and an attempt to remove a purulent lesion on her own in unsanitary conditions.

It should be remembered that skin infections may lead to complications in the form of staphylococcal pneumonia.

None declared.
None declared.
Hryniewicz W. Staphylococcal infections. In: Cianciara J, Juszczyk J. Infectious and parasitic diseases. Lublin: Czelej. 2012;825–831 [in Polish].
Samet A, Arłukowicz E, Nowicki R, Barańska-Rybak W. Staphylococcus aureus in the nasal cavity as a risk factor for skin diseases and systemic infections. Przew Lek. 2003;6(9):28–33 [in Polish].
Asgeirsson H, Thalme A, Weiland O. Staphylococcus aureus bacteremia and endocarditis - epidemiology and outcome: a review. Infect Dis (Lond). 2018;50(3):175–192.
Vos FJ , Kullberg BJ, Sturm PD, et al. Metastatic infectious disease and clinical outcome in Staphylococcus aureus and Streptococcus species bacteremia. Medicine (Baltimore). 2012;91(2):86–94.
Chouake J, Krausz A, Adler BL, Cohen HW, Nosanchuk JD, Friedman A. Management of cutaneous abscesses by dermatologists. J Drugs Dermatol. 2014;13(2):119–124.
Tong SY, Davis JS, Eichenberger E, Holland TL, Fowler VG Jr. Staphylococcus aureus infections: epidemiology, pathophysiology, clinical manifestations, and management. Clin Microbiol Rev. 2015;28(3):603–661.
Tsao TC, Tsai YH, Lan RS, Shieh WB, Lee CH. Pulmonary manifestations of Staphylococcus aureus septicemia. Chest. 1992;101(2):574-576.
Lasa JS, Fernández Recalde ML, Finn BC, Bruetman JE, Peroni J, Young P. [Bacteremia in patients hospitalized with cellulitis]. Medicina (B Aires). 2012;72(4):298-304 [in Spanish].
Lee CY, Kunin CM, Chang C, Lee SS, Chen YS, Tsai HC. Development of a prediction model for bacteremia in hospitalized adults with cellulitis to aid in the efficient use of blood cultures: a retrospective cohort study. BMC Infect Dis. 2016;16(1):581.
Saitz R, Ghali W, Moskowitz M. The impact of alcohol-related diagnoses on pneumonia outcomes. Arch Intern Med. 1997;157(13):1446–1452.
Devier J, Content J, Denys C, et al. High IL-6 serum levels and increased production by leukocytes in alcoholic liver cirrhosis. Clin Exp Immunol. 1989;77(2):221–225.
Gamble L, Mason CM, Nelson S. The effects of alcohol on immunity and bacterial infection in the lung. Med Mal Infect. 2006;36(2):72–77.
Brook I. Role of methicillin-resistant Staphylococcus aureus in head and neck infections. J Laryngol Otol. 2009;123(12):1301–1307.
Youssef D, Molony K. Staphylococcus aureus bacteremia in adults. In: Enany S, Crotty Alexander L. Frontiers in Staphylococcus aureus. London: Intech Open. 2017;117–130.
Vandenesch F, Naimi T, Enright MC, et al. Community-acquired methicillin-resistant Staphylococcus aureus carrying Panton-Valentine leukocidin genes: worldwide emergence. Emerg Infect Dis. 2003;9(8):978–984.
Karakulska J, Nawrotek P, Fijałkowski K. Panton-Valentine leukocidin – known and unknown aspects. Post Microbiol. 2015;54,2:250-257 [in Polish].
Olcay L, Secmeer G, Gogus S, Akcoren Z. Pathological case of the month. Fatal hemorrhagic staphylococcal pneumonia. Arch Pediatr Adolesc Med. 1995;149(8):925–926.
Petros S, Eggers B, Heuer M, et al. Severe community acquired pneumonia due to Staphylococcus aureus. Intensive Care Med. 1998;24(2):189.
Lina G, Piémont Y, Godail-Gamot F, et al. Involvement of Panton-Valentine leukocidin-producing Staphylococcus aureus in primary skin infections and pneumonia. J Clin Infect Dis. 1999;29(5):1128–1132.
Buwalda M, Speelber B. Metastatic staphylococcal lung abscess due to a cutaneous furuncle. Neth J Med. 1995;47(6):291–295.