Assuntos
Encéfalo/diagnóstico por imagem , Encefalocele/diagnóstico , Encefalocele/etiologia , Punção Espinal/efeitos adversos , Infecções Bacterianas/complicações , Criança , Evolução Fatal , Escala de Coma de Glasgow , Humanos , Pressão Intracraniana/fisiologia , Masculino , Meningoencefalite/diagnóstico , Meningoencefalite/microbiologia , Fatores de Tempo , Tomografia Computadorizada por Raios XRESUMO
Thoracentesis is a procedure often performed in children with pleural effusions to assist in diagnosis and management. Its safety and utility for immunocompromised patients with neutropenia (absolute neutrophil count, <1,500 polymorphonuclear leukocytes and band forms per microL) is unclear. We reviewed our experience over a 10-year period to evaluate the role of thoracentesis for neutropenic children with cancer who had pulmonary effusions of presumed infectious etiology. Twenty-two patients were identified, and 18 had absolute neutrophil counts of < or = 500/microL. Empirical antibiotics had been administered to 95% of these patients and antifungal agents to 72%. Two patients' cultures were positive for fungal organisms: Aspergillus terreus in one case and Candida albicans in the other. Both of these patients had been receiving antifungal therapy. Therapy was altered for these two patients plus one additional patient in whose pleural fluid tumor cells were unexpectedly found. Eight of the remaining 19 patients underwent another diagnostic procedure, yielding five additional diagnoses. In conclusion, thoracentesis is safe and should be considered as a diagnostic test for febrile neutropenic patients with pulmonary effusions of presumed infectious etiology, although more invasive tests may be warranted.
Assuntos
Neoplasias/complicações , Neutropenia/complicações , Derrame Pleural Maligno/diagnóstico , Punções , Adolescente , Adulto , Infecções Bacterianas/complicações , Infecções Bacterianas/diagnóstico , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Micoses/complicações , Micoses/diagnóstico , Neutropenia/tratamento farmacológico , Neutropenia/fisiopatologia , Derrame Pleural Maligno/complicações , Derrame Pleural Maligno/imunologia , Estudos Retrospectivos , Viroses/complicações , Viroses/diagnósticoRESUMO
We describe a case of an adolescent with sickle-beta+ thalassemia who developed fatal fat embolism syndrome. After presenting with bone pain, the patient developed mental status changes, hypoxemia, and died following cardiorespiratory arrest.
Assuntos
Anemia Falciforme/complicações , Embolia Gordurosa/etiologia , Embolia Pulmonar/etiologia , Talassemia beta/complicações , Adolescente , Anemia Falciforme/patologia , Embolia Gordurosa/patologia , Evolução Fatal , Feminino , Humanos , Microcirculação/patologia , Alvéolos Pulmonares/irrigação sanguínea , Alvéolos Pulmonares/patologia , Embolia Pulmonar/patologia , Talassemia beta/patologiaRESUMO
Henoch-Schönlein purpura is a common cause of vasculitis in children. This condition is unusual in infants and children younger than 2 years. We describe a 4-month-old infant with infantile Henoch-Schönlein purpura and review the clinical spectrum, differential diagnoses, and the histopathologic features of the disease. Its relations to Henoch-Schönlein purpura in older children are discussed.