Abstract

Introduction: Methicillin-resistant Staphylococcus aureus (MRSA) has emerged as a significant cause of invasive infections in the pediatric population. While community acquired MRSA (CA-MRSA) is often associated with skin and soft tissue infections, it can present with life-threatening systemic manifestations, including sepsis, pneumonia, osteomyelitis, and septic arthritis. Case Report: An 11-year-old previously healthy boy presented with a 10-day history of leg pain following minor trauma, fever, generalized vesicular rash, and progressive inability to stand. Initial evaluation suggested viral myositis, but the patient deteriorated rapidly with respiratory distress and signs of systemic inflammation. Imaging revealed bilateral pneumonia and pericardial effusion. Laboratory investigations showed leukocytosis, thrombocytopenia, elevated CK-MB, and inflammatory markers. He was managed with intravenous fluids, acyclovir, and empiric antibiotics. However, persistent fever and worsening hip pain prompted further imaging, which revealed osteomyelitis of the right femur with adjacent soft tissue collection and right hip joint infective synovitis. Blood culture grew MRSA, and antibiotics were escalated to vancomycin and clindamycin. Surgical debridement and drainage were performed, and the child improved significantly thereafter. Conclusion: This case highlights the aggressive nature of CA-MRSA and its potential to mimic viral illness initially. It emphasizes the importance of early imaging, culture guided antibiotic escalation, and timely surgical intervention in managing pediatric MRSA osteoarticular infections.

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