Severe systemic vasculitis in a neonate

Autor: Regula Markwalder, Mario G. Bianchetti, Giacomo D. Simonetti, Juerg Pfenninger, Martin Tönz
Rok vydání: 2006
Předmět:
Zdroj: Simonetti, Giacomo D; Markwalder, Regula; Tönz, Martin; Pfenninger, Juerg; Bianchetti, Mario G (2007). Severe systemic vasculitis in a neonate. European journal of pediatrics, 166(4), pp. 381-2. Berlin: Springer-Verlag 10.1007/s00431-006-0242-9
ISSN: 1432-1076
0340-6199
DOI: 10.1007/s00431-006-0242-9
Popis: A full-term male newborn, the child of a healthy Swiss woman with normal urinalysis and negative tests for hepatitis B, hepatitis C and human immunodeficiency virus, was referred for surgical repair of esophageal atresia and distal tracheoesophageal fistula at the age of 2 days. Three days later, the diagnosis of anastomotic leak and infected right-sided pneumothorax was made, which required parenteral antimicrobial treatment with clindamycin and amoxicillin based on positive cultures for both viridans streptococci and coagulase-negative staphylococci. In spite of that the child developed a severe pleural empyema, which was treated with thoracotomy and decortication. The antimicrobial medication was continued up to the age of 21 days. Two days later, the condition of the child deteriorated, as indicated by the appearance of tachypnea, progressive cyanosis, and reduced diuresis. Chest x-ray findings disclosed intraalveolar fluid accumulation. Laboratory values were as follows: hemoglobin, 91 g/l (reference range, 100–150 g/l); white blood cell count, 19.8×10/l (reference range, 5.0–12.5×10/l); platelets, 39×10/l (reference range, 150–300×10/l); C-reactive protein, 118 mg/l (reference range, ≤5 mg/l); creatinine, 92 μmol/l (reference range, ≤47 μmol/l). A blood film disclosed a moderate eosinophilia of 3.9×10/l (reference range: ≤0.8×10/l). Urinalysis disclosed severe proteinuria, hematuria and red blood cell casts. Two days later, a generalized maculopapular rash was noted. Antineutrophil cytoplasmic and antinuclear autoantibodies, and antibodies against the Ro and La particle were not present in either the patient or his mother. The tentative diagnosis of systemic vasculitis was confirmed by a skin biopsy demonstrating a characteristic leucocytoclastic vasculitis with marked eosinophilia (Fig. 1). Immunofluorescence studies with antisera against immunoglobulins were not performed. Medical treatment with methylprednisolone 3 mg/kg body weight daily was followed within 24 hour by polyuria Eur J Pediatr (2007) 166:381–382 DOI 10.1007/s00431-006-0242-9
Databáze: OpenAIRE
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