RESUMO
Alcaligenes faecalis is a gram-negative organism that is commonly found in the environment and may also be a part of normal fecal flora in humans. Although various infections with this bacteria have been described in the pediatric population, it has not been previously identified in infections as the pathogen after a dog bite. A case of a 19-month-old boy is presented with a cellulitis secondary to a dog bite, which failed oral antibiotic therapy, and progressed to worsening fever and swelling. The patient ultimately required hospitalization, intravenous antibiotics, and incision and drainage. The wound culture grew A. faecalis, whose identity was confirmed through recombinant DNA sequence analysis. Although it has been identified in cat bite wounds, A. faecalis has not been cited in the literature before in an infection after a dog bite.
Assuntos
Alcaligenes faecalis , Antibacterianos/uso terapêutico , Mordeduras e Picadas/complicações , Celulite (Flegmão)/etiologia , Animais , Celulite (Flegmão)/tratamento farmacológico , Cães , Humanos , Lactente , MasculinoRESUMO
We present the case of a healthy 13-year-old female adolescent who developed acute progressive swelling and pain in her right upper extremity that was secondary to an acute deep venous thrombosis of her right subclavian vein. Dynamic imaging revealed subclavian vein compression at the junction of the first rib and proximal third of the clavicle consistent with Paget-Schroetter syndrome, also known as effort-related thrombosis. The compressive etiology of her thrombus was most likely related to her cheerleading activity, in which she served as the pyramid base. The patient received multimodal therapy including anticoagulation, mechanical and site-directed thrombolysis, and a first rib resection. This case illustrates that frontline providers should have a high index of suspicion for an upper extremity thrombosis in pediatric patients who present with unilateral arm swelling.
Assuntos
Anticoagulantes/uso terapêutico , Veia Subclávia/patologia , Terapia Trombolítica/métodos , Trombose Venosa Profunda de Membros Superiores/diagnóstico , Adolescente , Feminino , Humanos , Flebografia , Costelas/cirurgia , Trombose Venosa Profunda de Membros Superiores/terapiaRESUMO
We present the case of a 1-year-old healthy boy who was taking oral antibiotics for an otitis media and then developed an erythematous penile lesion that rapidly became ulcerated. He was admitted to the hospital for further diagnostic studies and intravenous therapy, and his wound culture grew Pseudomonas aeruginosa, consistent with the diagnosis of ecthyma gangrenosum. Serial blood counts also demonstrated a progressive neutropenia, and an immunodeficiency evaluation resulted in the diagnosis of autoimmune neutropenia of childhood. This case illustrates the importance of culturing wounds and the need for clinicians to recognize the characteristic features of ecthyma gangrenosum, to initiate appropriate antipseudomonal antibiotic therapy empirically, and to evaluate for a possible immunodeficiency, even in the apparently healthy child.
Assuntos
Genitália Masculina/patologia , Infecções por Pseudomonas/tratamento farmacológico , Infecções por Pseudomonas/microbiologia , Úlcera Cutânea/tratamento farmacológico , Úlcera Cutânea/microbiologia , Antibacterianos/uso terapêutico , Ectima/microbiologia , Ectima/patologia , Serviço Hospitalar de Emergência , Gangrena/microbiologia , Gangrena/patologia , Genitália Masculina/microbiologia , Humanos , Lactente , Masculino , Infecções por Pseudomonas/patologia , Pseudomonas aeruginosa/isolamento & purificação , Úlcera Cutânea/patologiaRESUMO
Meningoencephalitis and acute disseminated encephalomyelitis (ADEM) are both neurological disease processes, but there have been few cases of meningoencephalitis progressing to ADEM in the pediatric population. A case of a 4-year-old girl with an initial diagnosis of meningoencephalitis is presented here, whose initial presentation was manifested by prolonged fever, gray matter signal abnormality on brain magnetic resonance imaging, cerebrospinal fluid pleocytosis, and a markedly irritable mental status. As her neurological examination changed with focal abnormalities, a repeat magnetic resonance imaging demonstrated new areas of both gray and white matter signal abnormality, consistent with ADEM. Her symptoms and imaging findings completely resolved with a course of methylprednisolone. Based on the literature and this current case, it is our recommendation to consider ADEM as a diagnosis if meningoencephalitis is not improving.