Hyperferritinemic sepsis secondary to invasive Toxoplasma gondii in a child with untreated HIV / Sepsis hiperferritinémica secundaria a Toxoplasma gondii invasiva en un paciente pediátrico con virus de inmunodeficiencia humana sin tratamiento

Abstract Background: Untreated human immunodeficiency virus (HIV)-immunosuppressed pediatric patients show high morbidity and mortality from opportunistic infections. Limited cases of hyperferritinemic sepsis have been described in patients with toxoplasmosis. Case report: We describe the case of a 13-year-old female patient with a history of untreated HIV who presented with hyperferritinemic sepsis secondary to Toxoplasma gondii infection and Pneumocystis jirovecci pneumonia. She received ventilatory support, inotropic drugs, treatment for opportunistic germs, and high-dose corticosteroids, but with unfavorable evolution. Conclusions: The global approach to sepsis with elevated ferritin guides to using of therapies aimed at neutralizing the severe inflammatory response. A timely diagnosis would allow prompt treatment and minimize complications.

Resumen Introducción: Los pacientes pediátricos inmunodeprimidos por el virus de la inmunodeficiencia humana (VIH) sin tratamiento presentan una elevada morbilidad y mortalidad por infecciones oportunistas. Se han descrito limitados casos de sepsis hiperferritinémica en pacientes con toxoplasmosis. Caso clínico: Se describe el caso de una paciente de 13 años con antecedente de VIH sin tratamiento que presentó sepsis hiperferritinémica secundaria a una infección por Toxoplasma gondii y neumonía por Pneumocystis jirovecci. Recibió soporte ventilatorio, uso de inotrópicos, tratamiento para gérmenes oportunistas y corticoides en altas dosis, pero su evolución fue desfavorable. Conclusiones: El abordaje global de la sepsis con ferritina elevada orienta a utilizar terapias dirigidas a neutralizar la respuesta inflamatoria severa, por lo que un diagnóstico oportuno permitiría iniciar el tratamiento prontamente y minimizar las complicaciones.

Complications and neurologic deterioration after bilateral decompressive craniectomy in Gunshot penetrating brain injury in children

Background: Penetrating skull injuries in pediatrics (TPC) occupy a special place due to their rarity. The aim is to provide an overview of the current evidence on decompressive craniectomy in children, to describe the indications and to detail the complications. Reporte case: We present the case of a 12- year-old boy who suffered a TPC by a projectile that perforated his head, causing multiple brain injuries, and underwent early bilateral decompressive craniectomy, presenting the complications and neurological disabilities typical of the injury and surgery, with a reserved evolution and prognosis. Conclusions: Pediatric penetrating skull injuries should be of individualized management, type of injury and disease, experience of the treatment team, and the decision should always be consensual in front of the benefits and risks in the short and long term.

Introducción: Los traumatismos craneales penetrantes en pediatría (TPC) ocupan un lugar especial debido a su rareza. El objetivo es ofrecer una visión general de la evidencia actual sobre la craniectomía descompresiva en niños, describir las indicaciones y detallar las complicaciones. Reporte de caso: Presentamos el caso de un niño de 12 años que sufrió un TPC por un proyectil que le perforó la cabeza, causándole múltiples lesiones cerebrales, y fue sometido a craniectomía descompresiva bilateral temprana, presentando las complicaciones y discapacidades neurológicas propias de la lesión y la cirugía, con una evolución y pronóstico reservados. Conclusiones: Los traumatismos craneales penetrantes pediátricos deben ser de manejo individualizado, tipo de lesión y enfermedad, experiencia del equipo tratante, y la decisión debe ser siempre consensuada frente a los beneficios y riesgos a corto y largo plazo.

Síndrome da encefalopatia posterior reversível em uma criança com síndrome inflamatória multissistêmica grave devido à COVID-19 / Posterior reversible encephalopathy syndrome in a child with severe multisystem inflammatory syndrome due to COVID-19

RESUMO A síndrome da encefalopatia posterior reversível é uma rara síndrome clínica e radiológica caracterizada por edema vasogênico da matéria branca dos lobos occipital e parietal, que geralmente são simétricos, resultante de uma manifestação secundária de disfunção aguda do sistema cerebrovascular posterior. Descrevemos um caso de síndrome de encefalopatia posterior reversível secundária à infecção por SARS-CoV-2 em um menino de 9 anos de idade que desenvolveu insuficiência respiratória hipoxêmica aguda e necessitou de ventilação mecânica assistida. A criança desenvolveu síndrome inflamatória multissistêmica e foi monitorada na unidade de terapia intensiva pediátrica, tendo-lhe sido fornecidos ventilação mecânica e agentes vasoativos para suporte hemodinâmico. Além disso, desenvolveu manifestações clínicas pulmonares e extrapulmonares juntamente de manifestações neuropsiquiátricas que necessitavam de seguimento cuidadoso, tendo sido verificadas por ressonância magnética cerebral para intervenção oportuna. Atualmente, há poucos relatos de crianças com síndrome da encefalopatia posterior reversível associada à síndrome inflamatória multissistêmica.

ABSTRACT Posterior reversible encephalopathy syndrome is a rare clinical and radiological syndrome characterized by vasogenic edema of the white matter of the occipital and parietal lobes, which are usually symmetrical, resulting from a secondary manifestation of acute dysfunction of the posterior cerebrovascular system. We describe a case of posterior reversible encephalopathy syndrome secondary to SARS-CoV-2 infection in a 9-year-old boy who developed acute hypoxemic respiratory failure and required assisted mechanical ventilation. The child developed multisystem inflammatory syndrome, and he was monitored in the pediatric intensive care unit and was provided mechanical ventilation and vasoactive agents for hemodynamic support. Additionally, he developed pulmonary and extrapulmonary clinical manifestations along with neuropsychiatric manifestations that required close follow-up and were verified using brain magnetic resonance imaging for timely intervention. Currently, there are few reports of children with posterior reversible encephalopathy syndrome associated with multisystem inflammatory syndrome.