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Necrotising staphylococcal pneumonia — SCE Respiratory MCQ

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HardRespiratory InfectionsNecrotising staphylococcal pneumoniaSCE Respiratory

A 44-year-old man recovering from influenza develops recurrent fever, haemoptysis and pleuritic pain. CXR shows multilobar cavitating consolidation and WCC is 2.1 x 10^9/L. He is rapidly deteriorating. What is the most likely diagnosis?

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Correct answer: E — Necrotising Staphylococcus aureus pneumonia

Post-influenza rapid deterioration with haemoptysis, leukopenia and cavitating multilobar pneumonia is typical of necrotising Staphylococcus aureus, including PVL-producing strains. Mycoplasma is usually less fulminant and aspiration tends to involve dependent segments with risk factors. PE and chronic aspergillosis do not explain the post-influenza necrotising sepsis picture.

Reference: BTS CAP Guideline; UKHSA PVL Staphylococcus aureus guidance