Child abuse followed by fatal systemic Pseudomonas aeruginosa infection.

Child abuse has become an increasingly serious diagnostic challenge for physicians. The clinical manifestations include malnutrition and sometimes infection. In fact, stress in children has been reported to increase corticosteroid levels. As a consequence, the thymus begins an involution process, producing a severe impairment in cellular and humoral immunity. Here, we report the case of a 7-year-old child who suffered a prolonged history of abuse and died from a systemic Pseudomonas aeruginosa infection. An initial local chronic infection propagated to the pelvic lymph nodes in an immunologically weak body and evolved into abscesses/phlegmons of the pelvic tissue, sepsis, acute respiratory distress syndrome, multiple organ failure and finally, death. Abused children have to be considered as potentially immunologically impaired patients; therefore, it is very important to screen them for opportunistic infections. Moreover, a history of unusual or recurring infections may indicate abuse, especially neglect or malnutrition. In these cases, further investigations should be conducted to determine if a protective service case should be opened. Thus, there is a need for multidisciplinary cooperation to ensure the early identification and prevention of child abuse.

Sudden cardiac death associated with a coronary artery anomaly considered benign.

Separate origin of the left anterior descending and circumflex coronary artery from the left sinus of Valsalva is one of the most frequent benign coronary artery anomalies. We hereby report, for the first time, a case of sudden death in a young man with this anomaly. The clinicopathologic findings and the possible pathogenetic mechanisms are discussed.