Diffuse cerebral petechial hemorrhage in an 8-year-old girl with MRSA pneumonia and sepsis.

An 8-year-old girl in septic shock due to necrotizing methicillin-resistant Staphylococcus aureus (MRSA) pneumonia developed signs of end-organ damage, new right hemiplegia, and left gaze preference. Susceptibility-weighted MRI demonstrated extensive multifocal petechial hemorrhage preferentially at the gray-white matter interface due to septic microemboli (figure). Mechanisms of hemorrhage include small-vessel occlusion leading to mycotic aneurysm formation with rupture or pyogenic arteritis without aneurysm formation.(1) Intracranial hemorrhage associated with metastatic staphylococcal infections is rarely described(2) and is especially noteworthy with diffuse cerebral petechial hemorrhage in the setting of metastatic MRSA.