Bronchiolitis Obliterans in an Adult Male After Admission With Panton-Valentine Leucocidin Staphylococcal Pneumonia

A middle-aged man with no smoking or respiratory history presented with shortness of breath and facial swelling due to influenza. His condition deteriorated rapidly, and he required intensive care admission and intubation. He was found to have Panton-Valentine leucocidin (PVL) Staphylococcal pneumonia, with bilateral pneumothorax and subcutaneous emphysema. He responded well to antibiotics and chest drainage and was subsequently discharged. His follow-up radiology initially showed almost complete resolution. However, over the course of five years, he had multiple GP attendances and hospital admissions for recurrent infections with continued breathlessness on exertion. A follow-up CT suggested features of bronchiolitis obliterans (BO), which has not been previously recognised as associated with PVL Staphylococcal infections. Specialist teams have suggested active observation with consideration of transplantation in the event of deterioration. This case demonstrates that BO can be seen with previously unrecognised infectious aetiology and should be considered in any patient with appropriate symptomatology following a severe respiratory infection.