To: Death by community-based methicillin-resistant Staphylococcus aureus: case report - Critical Care Science (CCS)

To: Death by community-based methicillin-resistant Staphylococcus aureus: case report | To the Editor We read with interest Vieira et al.'s article about a 13-year-old male who died of necrotizing pneumonia caused by infection with community-acquired methicillin-resistant Staphylococcus aureus (CA-MRSA).⁽⁾ The patient was initially misdiagnosed with tonsillitis but developed pneumonia complicated by massive bronchial and pulmonary bleeding, extensive mediastinal and subcutaneous emphysema, sepsis, septic and hypovolemic shock, and disseminated intravascular coagulation with multiorgan ischemia.⁽⁾ Blood culture grew oxacillin-resistant S. aureus and multisensitive Haemophilus influenzae.⁽⁾ Despite extensive diagnostic and therapeutic measures, the patient died.⁽⁾ Autopsy revealed that the bacterial infection had caused tissue necrosis, leading to loss of integrity of the bronchial tree and leakage of air into the tissue, as well as necrosis of the vessel walls, resulting in diffuse hemorrhage of the alveolar and lower respiratory tract.⁽⁾ The case report is compelling, but some points should be discussed. [...]