Drowning with acute respiratory failure

We present the case of a 74-year-old male that was admitted to our Unit of Pulmonology for chlorinated freshwater drowning syndrome with acute hypoxemic respiratory failure. Despite an initial clinical response, with improvement of the respiratory failure and decreased number of the multifocal pulmonary opacities on chest CT, after about ten days from the admission, the patient developed intermittent fever (up to 39.3°C), re-worsening of the respiratory failure and pneumatocele. Blood cultures showed the presence of methicillin-resistant staphylococcal aureus (MRSA) sepsis. Despite many courses of different antibiotics, the patient died. MRSA is a rare cause of pneumonia after drowning with a high lethality rate.