Asplenia congénita y purpura fulminans neumocóccico en paciente pediátrico. Reporte de caso con necropsia y revisión del tema

Translated title of the contribution: Congenital asplenia and pneumococcal purpura fulminans in a pediatric patient. Case report with pathological findings and review

Katalina S. Bertrán, Alejandro F. Donoso, Pablo R. Cruces, Franco R. Díaz, Daniela S. Amagada

Research output: Contribution to journalReview articlepeer-review

7 Citations (Scopus)

Abstract

Absent or defective splenic function is associated with a high risk of fulminant bacterial infections, especially due to encapsulated bacteria. Not knowing this condition may delay medical treatment. Streptococcus pneumoniae is the leading cause of sepsis in these patients. Asplenic patients are at high risk for septic shock and eventually purpura fulminans, a life-threatening condition. We report the case of a 3 years old girl, with mitral stenosis and recurrent pneumonia that was admitted due to fever but in the next few hours presented hypotension, purpura and livedo reticularis. Laboratory test showed leucopenia (3.400/mm3), bandemia (43% of immature forms), thrombocytopenia, hypoprothombinernia and severe lactic acidosis (ph: 7.0 and lactic acid 11 mmol/1). The patient developed septic shock and multiorganic failure. Mechanical ventilation, volume resuscitation, vasoactive drugs and antibiotic therapy was initiated. Ultrasound was performed on the second day, demostrating asplenia. Peripheral blood smear showed Howell-Jolly bodies. Patient had a positive blood culture for penicillin-resistant Streptococcus pneumoniae (serotype 19F). Patient died of intracerebral hemorrhage after 8 days of admission. Necropsy confirmed asplenia and bilateral suprarenal haemorrhage. Absence of spleen can lead to life threatening infections, it is important to recognize it because vaccination and antibiotic prophylaxis can provide life-saving protection. This case provides a reminder to pursue asplenia as a potential underlying mechanism for invasive bacterial infection in children.

Translated title of the contributionCongenital asplenia and pneumococcal purpura fulminans in a pediatric patient. Case report with pathological findings and review
Original languageSpanish
Pages (from-to)55-59
Number of pages5
JournalRevista Chilena de Infectologia
Volume26
Issue number1
Publication statusPublished - Feb 2009

ASJC Scopus subject areas

  • Infectious Diseases
  • Public Health, Environmental and Occupational Health

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