Fatal Necrotising Pneumonia by Exfolative Toxin etE2-Producing <em>Staphylococcus aureus</em> Belonging to MLST ST152 in the Netherlands

We present a case of fatal necrotising Staphylococcus aureus pneumonia with underlying influenza infection. Next generation sequencing-based analysis showed that the isolate harbored the the newly-recognised exfolative toxin etE2 gene. Molecular epidemiologic analysis showed that the isolate belongs to the MSSA ST152 lineage, harboring PVL genes and edinB colocated to etE2 as distinctive virulence factors. The etE2 gene is present in all isolates of this lineage colocated to the exotoxin gene edinB, both implicated in the destruction of tissue integrity. We alert for the global emergence of this lineage causing serious infections in patients.