A Rare Case Report: Facial cellulitis secondary to Methicillin Resistant Staphylococcus Aureus Infection in an 8-month-old infant with Dengue Fever.

Abstract

Background: Dengue Fever (DF), a mosquito-borne illness caused by the Dengue virus (DenV), is known for its systemic and haemorrhagic manifestations. Secondary bacterial infections, though rare in paediatric patients, can complicate the clinical course, especially in severe forms like Dengue Haemorrhagic Fever (DHF). Methicillin-resistant Staphylococcus aureus (MRSA) septicaemia is a life-threatening condition, seldom reported in association with DF, and facial cellulitis as a consequence has not been previously documented in children.

Case Presentation: We report a unique case of an 8-month-old female who presented with persistent fever, facial swelling, and oral lesions following recent hospitalization for dengue fever complicated by bronchopneumonia. Clinical examination revealed facial cellulitis with periorbital oedema and intraoral lesions. Blood and pus cultures confirmed MRSA and Pseudomonas aeruginosa, indicative of MRSA septicaemia secondary to facial cellulitis. The patient was managed with intravenous vancomycin, clindamycin, and piperacillin-tazobactam based on culture sensitivity, along with supportive care and correction of nutritional deficiencies. Clinical improvement was noted by day 9, with complete recovery following surgical drainage and a 21-day treatment course.

Conclusion: To our knowledge, this is the first documented case of MRSA septicemia presenting as facial cellulitis in an infant with dengue fever. Early recognition, appropriate cultures, and timely initiation of MRSA-targeted antibiotics are critical in managing such rare but potentially life-threatening complications. This case also emphasizes the need for heightened infection control and vigilance for secondary infections in pediatric dengue care.

Keywords:

Dengue, Dengue Hemorrhagic Fever, Methicillin resistant staphylococcus aureus infection, Facial Cellulitis, Periorbital Edema, Septicemia

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