RESUMO
OBJECTIVES: To report, to the best of our knowledge, the youngest patient with Lemierre syndrome. DESIGN: Descriptive case report with review of the pediatric literature. SETTING: Pediatric intensive care unit in a tertiary referral hospital. DATA SOURCE: Systemic review of the literature, including PubMed (English-only journals) and major textbooks. PATIENT: We report a 5-month-old boy who presented with fever and a perforated left-sided otitis media. He developed left-sided complicated otitis media with retroauricular fluid collection, mastoiditis, and temporomandibular joint effusion. The clinical picture was complicated by a left internal jugular vein and left lateral sinus thrombosis. Fusobacterium necrophorum grew in the pus culture. INTERVENTIONS: Low molecular weight heparin. MEASUREMENTS AND MAIN RESULTS: No immunodeficiency and no thrombophilia were identified as predisposing conditions for Lemierre syndrome. Surgical drainage, early and adequate antibiotic treatment, and anticoagulation were followed by complete recovery. CONCLUSIONS: This case report illustrates that Lemierre syndrome can occur in infants without underlying risk factors for severe infections or thrombotic complications.
Assuntos
Infecções por Fusobacterium/diagnóstico por imagem , Fusobacterium/isolamento & purificação , Otite Média/complicações , Tromboflebite/etiologia , Anticoagulantes/uso terapêutico , Febre/etiologia , Infecções por Fusobacterium/complicações , Infecções por Fusobacterium/patologia , Heparina de Baixo Peso Molecular/uso terapêutico , Humanos , Lactente , Veias Jugulares/diagnóstico por imagem , Veias Jugulares/patologia , Imageamento por Ressonância Magnética , Masculino , Sepse/etiologia , Síndrome , Tromboflebite/tratamento farmacológico , Tomografia Computadorizada por Raios XRESUMO
Linear growth occurs during development and the childhood years until epiphyseal fusion occurs. This process results from endochondral ossification in the growth plates of long bones and is regulated by systemic hormones and paracrine or autocrine factors. The major regulators of developmental and childhood growth are GH, IGF-I, glucocorticoids, and thyroid hormone. Sex steroids are responsible for the pubertal growth spurt and epiphyseal fusion. This review will consider interactions between GH, IGF-I, glucocorticoids, and thyroid hormone during linear growth. It is well known from physiologic and clinical studies that these hormones interact at the level of the hypothalamus and pituitary. Interacting effects on peripheral tissues such as liver are also well understood, but we concentrate here on the epiphyseal growth plate as an important and newly appreciated target organ for convergent hormone action.