EC Paediatrics

Gastrointestinal involvement associated with invasive Staphylococcus aureus infection is uncommon and remains poorly characterized in infants. We report the case of a 9-month-old infant admitted to the pediatric intensive care unit with severe disseminated S. aureus infection. Chest CT demonstrated multiple bilateral pulmonary nodules, several showing central cavitation and a predominantly peripheral distribution, consistent with septic pulmonary emboli, associated with multifocal parenchymal consolidations and a small pleural effusion. A staphylococcal abscess of the gluteal region provided an additional infectious focus. The clinical course was complicated by septic shock with persistent hypotension requiring norepinephrine and acute kidney injury. Staphylococcus aureus was also isolated from stool samples. The infant subsequently developed progressive abdominal distension. Because of renal impairment, abdominopelvic CT was performed without intravenous contrast and demonstrated marked bowel distension with segmental circumferential wall thickening and spontaneous mural hyperattenuation, suggesting a possible hemorrhagic component. No definite pneumatosis intestinalis or pneumoperitoneum was identified. Abdominal distension persisted and serum lactate levels progressively increased. Although the clinical, microbiological, and imaging findings supported intestinal involvement occurring during disseminated S. aureus infection, concomitant hypoperfusion-related bowel injury was strongly suspected because of sustained hypotension and vasopressor requirement. Intestinal ischemia could not be definitively confirmed in the absence of contrast-enhanced imaging, angiography, surgery, or histopathology. Despite intensive care management, the infant developed progressive multiorgan failure and died. This case highlights an unusual gastrointestinal manifestation of severe invasive staphylococcal infection and the potential coexistence of infectious and hypoperfusion-related mechanisms of intestinal injury.

Keywords: Staphylococcus aureus; Disseminated Infection; Intestinal Involvement; Septic Pulmonary Emboli; Septic Shock; Bowel Ischemia; Infant; Computed Tomography