A 21-month-old African girl born in Belgium without medical history or travel history (for her and her family) and fully vaccinated, presented with a 3-day high fever to another emergency department where treatment by oral amoxicillin had been initiated. Four days later, because of persistent high fever and the onset of a one-sided cervical bulk, she came to the emergency room of our institution.
Cervical bulk was indurated, painful, and measured 3 cm on its long axis, at palpation. Initial blood analysis demonstrated a major inflammatory syndrome with a white blood cell count of 22,330/mul (with 16,190/mul absolute neutrophils) and a CRP of 180 mg/L. Indeed, a cervical MRI showed an abscess cavity measuring 10 cm long and 2 cm wide on a necrotic lymph node. This abscess extended to the anterior parapharyngeal space fusing to the middle mediastinum, next to cardiac vessels. Its massive extension reduced the size of the trachea (Figure 2).
After diagnostic imaging, IV ceftriaxone (100 mg/kg/day) associated with IV clindamycin (30 mg/kg/day) were started and the abscess was drained under ultrasound guidance. MSSA was isolated from the abscess sample but blood cultures stayed negative. After microbiological results, antibiotic therapy was changed to flucloxacillin (200 mg/kg/day) only and continued for 15 days (10 intravenously). A PVL test yielded positive in a spa-type t008 isolate. The PCR for other exotoxins (TSST-1, eta, and etb) were negative. Enterotoxins had not been investigated. She did not report any close contact with people having skin or soft tissue infections.
The total length of her hospital stay was 11 days including 5 at PICU. She had no sequelae of the infection at the 1-year follow-up.