RESUMO
We report the diagnostic and therapeutic challenges in an unusually fulminant presentation of measles, presenting as severe necrotizing bronchiolitis with secondary hemophagocytic lymphohistiocytosis (HLH) in the absence of classical clinical features in an immunocompromised host on maintenance chemotherapy. Our patient had presented with features of a viral pneumonitis without the classical exanthem, in combination with HLH. Although rhinovirus-induced HLH was highly unusual, the positive rhinovirus swab result had distracted us from the eventual diagnosis. This calls for greater impetus to increase awareness and public education to improve vaccination rates and herd immunity to curb outbreaks and protect the immunocompromised patients.
Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimioterapia de Manutenção , Sarampo/diagnóstico , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Corticosteroides/uso terapêutico , Anti-Infecciosos/uso terapêutico , Pneumonia em Organização Criptogênica/diagnóstico , Erros de Diagnóstico , Oxigenação por Membrana Extracorpórea , Evolução Fatal , Humanos , Linfo-Histiocitose Hemofagocítica/diagnóstico , Linfo-Histiocitose Hemofagocítica/etiologia , Masculino , Sarampo/complicações , Sarampo/terapia , Mercaptopurina/administração & dosagem , Metotrexato/administração & dosagem , Insuficiência de Múltiplos Órgãos/etiologia , Pancitopenia/etiologia , Infecções por Picornaviridae/complicações , Infecções por Picornaviridae/diagnóstico , Infecções por Picornaviridae/virologia , Troca Plasmática , Pneumonia Viral/diagnóstico , Rhinovirus/isolamento & purificação , Sepse/etiologia , SobreviventesRESUMO
This report describes the clinical features of H1N1 2009 influenza infection in 10 young renal patients receiving chronic dialysis or immunosuppressants, and to compare their durations of viral shedding with 20 healthy controls. Although patients shed the virus for longer periods compared with controls, all had a self-limited clinical course. Studies on indications, dosages and durations of antiviral therapy in renal and immunocompromised patients are warranted.
Assuntos
Antivirais/administração & dosagem , Hospedeiro Imunocomprometido , Vírus da Influenza A Subtipo H1N1/isolamento & purificação , Influenza Humana/tratamento farmacológico , Influenza Humana/patologia , Nefropatias/complicações , Oseltamivir/administração & dosagem , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Influenza Humana/virologia , Nefropatias/terapia , Masculino , Diálise Renal , Singapura , Fatores de Tempo , Resultado do Tratamento , Eliminação de Partículas Virais , Adulto JovemRESUMO
We report on 3 immunocompromised children infected with pandemic influenza A/H1N1/2009 in whom mixtures of oseltamivir-susceptible and oseltamivir-resistant viral populations developed, despite them receiving relatively short-term courses of oseltamivir. In addition, it was found that bacterial coinfections were common, indicating that empiric, antibiotics should be considered in such patients when infected with influenza virus.