General Intensive Care Unit, Cochin Hospital, APHP, Paris, France.
Infection. 2010 Jun;38(3):223-5. doi: 10.1007/s15010-010-0002-7. Epub 2010 Mar 17.
We describe a rare case of multifocal necrotizing fasciitis (NF) complicating a single vaccine injection. Injection of hepatitis B vaccine of a 16-year-old immunocompetent woman developed into rapidly spreading multifocal NF of the right arm and the thighs, with septic shock. Treatment with antimicrobial therapy and surgical debridements allowed amputation to be avoided with a favourable outcome. The etiological agent was a methicillin-sensitive Staphylococcus aureus (MSSA) isolate harboring the Panton-Valentine leukocidin (PVL) and five enterotoxins. PVL has recently been reported in large series of methicillin-resistant SA cases and has been associated with necrotizing infections. Some strains of MSSA could harbor PVL and enterotoxins. PCR investigation is not frequent but could improve the understanding of the mechanisms of lesions. This case is in keeping with the increasing incidence of MSSA harboring PVL and enterotoxins with multifocal dissemination NF and emphasizes the necessary precautions for skin decontamination before vaccine injection.
我们描述了一例罕见的多灶性坏死性筋膜炎（NF）合并单次疫苗注射的病例。一名 16 岁免疫功能正常的女性接种乙型肝炎疫苗后，右侧手臂和大腿迅速出现多发性 NF，并伴有脓毒性休克。抗菌治疗和手术清创治疗避免了截肢，预后良好。病原体是一株携带杀白细胞素（PVL）和五种肠毒素的耐甲氧西林金黄色葡萄球菌（MSSA）分离株。PVL 最近在大量耐甲氧西林 SA 病例中被报道，并与坏死性感染有关。一些 MSSA 菌株可能携带 PVL 和肠毒素。PCR 检测并不常见，但可以帮助更好地了解病变机制。本例与携带 PVL 和肠毒素的 MSSA 引起的多灶性播散性 NF 的发病率增加相一致，并强调了疫苗注射前皮肤去污的必要预防措施。
