RESUMO
Stenotrophomonas maltophilia is a Gram-negative bacterium, usually considered a nosocomial pathogen. Its role in community-acquired infections has been reported, but it is still not typically included in differential diagnoses of patients not exposed to the healthcare system. Recently, some reports suggested that liver diseases might also act as a possible risk factor for community-acquired S. maltophilia bloodstream infection. We report a case of a 77-year-old woman with a history of cirrhosis who was diagnosed with community-acquired S. maltophilia bloodstream infection. S. maltophilia not only causes hospital-acquired infections but is also emerging as a pathogen in community settings. Although community-onset infection is still rare and might have lower mortality, this antibiotic-resistant bacterial species should be considered a possible pathogen in patients with liver cirrhosis. Although trimethoprim-sulfamethoxazole is considered the first-line treatment, a study in vitro and a 4-year review of S. maltophilia susceptibility in our institution found that the bacteria were more susceptible to minocycline than to trimethoprim-sulfamethoxazole. Therefore, minocycline might become the first-line treatment in the future.
RESUMO
OBJECTIVES: Thyroid storm (TS) is a rare but life-threatening condition caused by decompensated hyperthyroidism. There is no consensus on how to diagnose pediatric TS. We report three pediatric cases of TS presenting with central nervous system (CNS) and gastrointestinal (GI) symptoms as the initial presentation of Graves' disease. CASE PRESENTATION: They were previously healthy adolescents without family history of thyroid disease. CNS symptoms varied from agitation to coma. GI symptoms included abdominal pain, vomiting, and diarrhea. Their laboratory studies revealed thyrotoxicosis and positive result of thyroid-stimulating antibody (TSAb). They were admitted to the intensive care unit (ICU) and received the combination of an antithyroid drug, Lugol's solution, a beta antagonist, and hydrocortisone. The most severe case was a 13 year-old Japanese girl who presented with loss of consciousness and hemodynamic shock. She died after 5 days of intensive treatment. CONCLUSIONS: Pediatricians should consider TS in the differential diagnosis when a patient exhibits both CNS and GI symptoms.
