A Case of Delayed-Onset Posthypoxic Leukoencephalopathy in a Pediatric Patient.

We present a 16-year-old female status post traumatic brain injury from severe motor vehicle crash with prolonged extrication. Initially with a Glasgow Coma Scale of 4 and blood pressure of 80/40, she required emergent intubation. Head computed tomography was notable for skull fracture with hematoma, diffuse axonal injury, and 6-mm midline shift with right uncal herniation. On hospital day 1, she underwent decompressive R hemicraniectomy. She received neuroprotective treatment including a hypocarbic, hypernatremic state with close blood pressure monitoring for appropriate cerebral perfusion. On hospital day 4, patient was extubated and weaned off pressors and hypertonic saline. On hospital day 6, she was able to get out of bed to a chair, was speaking some words, following commands, and tolerating bites of food. On hospital day 8, she developed sudden agitation, combativeness, confusion, and could no longer follow commands. Magnetic resonance imaging now demonstrated confluent restricted diffusion consistent with acute changes. Imaging and examination findings were consistent with delayed-onset posthypoxic leukoencephalopathy.

Influenza A Infection and Anaphylaxis in a Pediatric Patient Hospitalized for Asthma Exacerbation.

Influenza infections can cause a variety of different systemic problems beyond respiratory symptoms. A 4-year-old boy with a history of atopy, infected with influenza A, presented to our hospital with an asthma exacerbation developed symptoms of anaphylaxis. He was treated with a full course of oseltamivir and symptoms resolved without recurrence of allergic reaction. Infections have been implicated as causes of anaphylaxis but this has mostly been limited to parasites. While viral infections have been documented as causes of urticarial rashes, anaphylaxis due to viral infection has only been reported once, in an adult patient. There have not been any reports of anaphylaxis related to influenza infections. Early recognition and treatment of patients with influenza may prevent progression of systemic allergic reactions. [Full article available at http://rimed.org/rimedicaljournal-2017-11.asp].

Enterovirus D68 and Panton-Valentine Leukocidin-Positive Staphylococcus aureus Respiratory Coinfection with Fatal Outcome.

A previously healthy 10-year-old girl with a 2-day history of upper respiratory illness and fever rapidly developed respiratory failure and sepsis with leukopenia, and expired despite attempts at resuscitation. Postmortem examination revealed bilateral necrotizing pneumonia and evidence of disseminated intravascular coagulation. Nasopharyngeal swabs and lung tissue submitted to the Centers for Disease Control and Prevention (CDC) were positive for Enterovirus D68 (EV-D68). Blood and lung cultures were positive for methicillin-resistant Staphylococcus aureus (MRSA). The isolates were submitted to the CDC and were found to be positive for the toxin Panton-Valentine leukocidin. We describe a fatality related to invasive toxin-mediated MRSA associated with EV-D68 coinfection, along with the clinical, laboratory, and autopsy findings, which provided important clues, prompting further investigation at the CDC to arrive at the correct diagnosis.

Thoracic empyema with scarlatiniform rash and acral desquamation: a case report.

A 5 year old girl with thoracic empyema developed a scarlatiniform rash and acral desquamation. Cultures from blood, throat, and pleural fluid all grew Streptococcus pyogenes, a common etiologic agent of pediatric thoracic empyema. The presence of a scarlatiniform rash and acral desquamation in children with a thoracic empyema may help identify the causative organism.