RESUMO
BACKGROUND: Varicella zoster virus (VZV) infection can cause temporary acquired protein S or C deficiency via cross reacting antibodies and consequently inducing a hypercoagulable state. CASE DESCRIPTION: A 6-year-old girl with a history of congenital cardiac disease was seen at an Emergency Department with acute chest pain, dyspnoea and fever, seven days after developing chicken pox. Diagnostic tests revealed massive infarction of the spleen, and a protein S and C deficiency. In addition, blood cultures revealed a Lancefield group A ß-haemolytic streptococcus (GABHS). The patient recovered fully after treatment with low molecular weight heparin and antibiotics. CONCLUSION: In this patient, septic emboli caused splenic infarction. Thromboembolic complications should be suspected in children with VZV who present with acute symptoms, in particular if bacterial superinfection is found.
Assuntos
Varicela/complicações , Embolia/complicações , Herpesvirus Humano 3/patogenicidade , Infarto do Baço/etiologia , Infecções Estreptocócicas/complicações , Doença Aguda , Varicela/imunologia , Criança , Reações Cruzadas , Embolia/imunologia , Feminino , Humanos , Deficiência de Proteína C/etiologia , Deficiência de Proteína C/imunologia , Deficiência de Proteína C/virologia , Deficiência de Proteína S/etiologia , Deficiência de Proteína S/imunologia , Deficiência de Proteína S/virologia , Infarto do Baço/imunologia , Infarto do Baço/virologia , Infecções Estreptocócicas/imunologiaRESUMO
Hereditary protein C deficiency is a hypercoagulable state associated with an increased risk for venous thrombosis. The recommended initial test for protein C is an activity (functional) assay, which may be clotting time based or chromogenic. The advantages and disadvantages of the various testing options are presented. The causes of acquired protein C deficiency are much more common than hereditary deficiency. Therefore, this article describes the appropriate steps to take when protein C activity is low, to confirm or exclude a hereditary deficiency. The causes of falsely normal results are also described, including lupus anticoagulants and direct thrombin inhibitors.