Background 10 month old previously healthy boy of Phillipino origin presented with a one week history of high grade fever associated with diarrohoea and two day history of chicken pox.

Presentation He was noted to be irritable with a hoarse voice and neck extension. He was noted to have high infection markers and was commenced on Ceftriaxone. He deteriorated over the next 24 h and his blood cultures were positive for S Aureus. On further testing the organism was identified as a PVL producing MRSA. Due to persistent fever and neck extension, a CT neck and thorax was performed which revealed an extensive retropharyngeal abscess extending into the mediastinum (Figure 1). An echocardiogram additionally showed a small tricuspid vegetation.

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Abstract G72(P) Figure 1

Extensive retropharyngeal abscess extending into the mediastinum

Management The abscess was surgically drained and the patient was treated with 6 weeks of Vancomycin and 2 weeks of oral Linezolid following IV therapy, after initial emperical therapy with Ceftriaxone. He required intensive care support following drainage and subsequently was managed on the paediatric infectious diseases unit. Follow-up scans showed a resolving infection. Pus culture from drainage grew the same organism. Further history form mother revealed that she had worked in the radiology department in an overseas hospital in the Phillipines previously. Immunology work up did not reveal evidence of an underlying primary immunodeficiency.

Conclusion Severe staphylococcal infections due to resistant or toxin producing organisms should be considered in children with predisposing risk factors and require care by a multidisciplinary team in a tertiary unit.