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Background <p>Community-acquired methicillin-resistant <i>Staphylococcus aureus</i> (CA-MRSA) is a rare cause of severe pneumonia in immunocompetent adults, accounting for less than 0.1% of community-acquired pneumonia. Its necrotizing presentation, reported to be driven by Panton-Valentine Leukocidin toxin, poses significant diagnostic and therapeutic challenges. We present a case of cavitary CA-MRSA pneumonia complicated by persistent bacteremia with the skip phenomenon.</p> Case Presentation <p>A 60-year-old man with chronic obstructive pulmonary disease presented with fever, cough, and progressive dyspnea. Imaging revealed cavitary left upper lobe pneumonia. Blood cultures repeatedly grew MRSA, while nasal swab and sputum cultures were negative. Despite initial therapy with ceftriaxone and azithromycin, his condition deteriorated. Intravenous vancomycin was initiated, later combined with ceftaroline. Cardiothoracic surgery deemed him a poor candidate for lobectomy due to extensive emphysematous changes. Serial blood cultures demonstrated intermittent negativity followed by recurrent MRSA growth, consistent with the skip phenomenon. After more than two weeks of bacteremia, clinical improvement and sustained negative cultures were achieved. The patient was discharged on oral clindamycin to complete a total of six-week antibiotic course. Follow-up chest imaging showed stabilization of cavitary lesions and resolution of consolidation.</p> Conclusions <p>This case highlights the importance of early suspicion for CA-MRSA pneumonia even in patients without typical risk factors. The skip phenomenon underscores the need for repeated blood cultures to confirm clearance of bacteremia. Prolonged combination antibiotic therapy can achieve favorable outcomes when surgical options are limited.</p>

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Cavitary Community-Acquired MRSA Pneumonia Presenting with Skip Phenomenon: A Case Report

  • 期刊论文

  • 发表日期：

    2025年12月6日

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  • Qutaiba Qafisheh,
  • Roaa Aljunaidi,
  • Abdalhakim Shubietah,
  • Muath Baniowda,
  • Mohanad Qwaider,
  • Mohammad Alqadi,
  • Nezam Altorok,
  • Mohammed AbuBaha,
  • Hossam Salameh

摘要

Background

Community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA) is a rare cause of severe pneumonia in immunocompetent adults, accounting for less than 0.1% of community-acquired pneumonia. Its necrotizing presentation, reported to be driven by Panton-Valentine Leukocidin toxin, poses significant diagnostic and therapeutic challenges. We present a case of cavitary CA-MRSA pneumonia complicated by persistent bacteremia with the skip phenomenon.

Case Presentation

A 60-year-old man with chronic obstructive pulmonary disease presented with fever, cough, and progressive dyspnea. Imaging revealed cavitary left upper lobe pneumonia. Blood cultures repeatedly grew MRSA, while nasal swab and sputum cultures were negative. Despite initial therapy with ceftriaxone and azithromycin, his condition deteriorated. Intravenous vancomycin was initiated, later combined with ceftaroline. Cardiothoracic surgery deemed him a poor candidate for lobectomy due to extensive emphysematous changes. Serial blood cultures demonstrated intermittent negativity followed by recurrent MRSA growth, consistent with the skip phenomenon. After more than two weeks of bacteremia, clinical improvement and sustained negative cultures were achieved. The patient was discharged on oral clindamycin to complete a total of six-week antibiotic course. Follow-up chest imaging showed stabilization of cavitary lesions and resolution of consolidation.

Conclusions

This case highlights the importance of early suspicion for CA-MRSA pneumonia even in patients without typical risk factors. The skip phenomenon underscores the need for repeated blood cultures to confirm clearance of bacteremia. Prolonged combination antibiotic therapy can achieve favorable outcomes when surgical options are limited.