Staphylococcal pneumonia, an actual challenge in pediatric practice – a case report

Introduction. Approximately 12 million children die every year in developing countries and one third of these deaths are caused by pneumonias. The assessment of radiological changes in dynamics owns a major role in establishing the diagnosis of staphylococcal pneumonia. The aim of this paper was to underline the diagnostic and treatment difficulties in a child with staphylococcal pneumonia. Case report. We present the case of a 2 years and 6-month-old male patient admitted in our clinic for hyperpyrexia, productive cough, rhinorrhea and anorexia. The clinical exam at admission pointed out influenced general status, pale ailing face, pallor, fever, productive cough, rhinorrhea, diminished breath sound on the right side, oxygen saturation 97% and anorexia, while de blood tests revealed severe leukocytosis with neutrophilia, anemia, and severely increased inflammatory biomarkers. The chest X-ray showed an opacity within the right inferior lobe. The blood culture was negative. We initiated symptomatic and antibiotic treatment (Ceftriaxone), but due to the unfavorable evolution, the control chest X-ray showed a consolidation area within the right inferior lobe and secluded basal pleural effusion as well as on the right lateral side. We performed also a chest computed tomography (CT), noticing a pneumonic process within two segments of the inferior right lobe, several grouped pneumatocele below the pleura, associating within both lungs areas of lobular hyperinflation. Thus, we raised the suspicion of staphylococcal pneumonia, and we initiated Vancomycin by vein, with favorable evolution. Conclusions. Staphylococcal pneumonia is a well-defined and described pathology in the literature, but still remains a contemporary pathology imposing multiple difficulties related to the diagnosis and management in pediatric patients.