ABSTRACT
WHAT IS KNOWN AND OBJECTIVE: Teicoplanin is a glycopeptide antibiotic used against documented or presumed methicillin-resistant infections. We report a 31-month-old boy with acute lymphocytic leukaemia who developed permanent complete atrioventricular block (CAVB) necessitating pacemaker insertion after receiving teicoplanin for Staphylococcus epidermidis bacteremia. CASE SUMMARY: Clinical assessment of the child revealed febrile neutropenia. After thorough assessment and work-up, the patient was started on teicoplanin intravenously after which he had sudden onset of bradycardia. Electrocardiography showed CAVB that eventually required permanent pacemaker insertion. Twenty-nine months from the incident, the patient is doing well. WHAT IS NEW AND CONCLUSION: We report on a case of teicoplanin-associated CAVB in a child with acute lymphoblastic leukaemia (ALL). This is one of only two similar cases reported in the literature. Teicoplanin remains the most probable cause. The use of teicoplanin should be approached cautiously in the setting of immunosuppression. Whether VZV contributed and teicoplanin triggered remains speculative. Physicians should be aware of this possible complication.
Subject(s)
Atrioventricular Block/chemically induced , Precursor Cell Lymphoblastic Leukemia-Lymphoma/microbiology , Staphylococcal Infections/drug therapy , Teicoplanin/adverse effects , Child, Preschool , Humans , Male , Neutropenia/chemically induced , Precursor Cell Lymphoblastic Leukemia-Lymphoma/blood , Staphylococcal Infections/blood , Staphylococcus epidermidis/isolation & purification , Teicoplanin/therapeutic useABSTRACT
A case of progressive shock and multisystem organ failure is reported for an 18 year old Lebanese woman, clinically diagnosed as toxic shock syndrome (TSS). The patient developed cough and dyspnea during hospitalization; chest CT angiography revealed thromboembolism of the pulmonary artery. CBC analysis showed leukocytosis with a white cell count (WCC) with a marked increase in PT and PTT coupled with reduced protein S, antithrombin III, and protein C levels. The patient improved gradually and was discharged from the hospital 7 days later on oral anticoagulation, and was followed up for six months with no disease recurrence or complications. To our knowledge, this is the first reported case in the literature of toxic shock syndrome associated with pulmonary thromboembolism.
Subject(s)
Shock, Septic/complications , Shock, Septic/diagnosis , Thromboembolism/complications , Thromboembolism/diagnosis , Adult , Female , Humans , Shock, Septic/blood , Thromboembolism/bloodABSTRACT
Varicella infections cause substantial morbidity and mortality in adolescents and adults. The primary infection, chickenpox, results in lifelong immunity to chickenpox. A seroprevalence study carried on adolescents 15-18 years of age attending schools in Lebanon showed 96.6% immunity to varicella. The positive predictive value for immunity to chickenpox based on history alone was 97.4%, whereas the negative predictive value was 4.5%. Coming from a bigger family was a statistically significant predictor of immunity to chickenpox. In a developing country like Lebanon the merits and limitations of implementing universal varicella vaccination is discussed in relation to seroprevalence and socioeconomic factors.
Subject(s)
Chickenpox Vaccine/administration & dosage , Chickenpox/immunology , Developing Countries , Adolescent , Chickenpox/epidemiology , Chickenpox/prevention & control , Chickenpox Vaccine/economics , Chickenpox Vaccine/immunology , Family Characteristics , Female , Humans , Lebanon , Male , Seroepidemiologic Studies , Social ClassSubject(s)
Ambulatory Care , Anti-Bacterial Agents/therapeutic use , Drug Prescriptions , Acute Disease , Adult , Age Factors , Animals , Anti-Bacterial Agents/adverse effects , Anti-Bacterial Agents/pharmacology , Bacteria/drug effects , Child , Child, Preschool , Drug Resistance, Microbial , Female , Gastroenteritis/drug therapy , Humans , Lebanon , Male , Middle Aged , Otitis Media/drug therapy , Respiratory Tract Infections/drug therapy , Urinary Tract Infections/drug therapyABSTRACT
Viral epiglottitis (supraglottitis) is a rare entity but its presentation can mimic that of bacterial epiglottis. Regardless of the causative agent, supraglottitis is a serious disease mostly affecting children and rarely seen in adults. Early suspicion and proper evaluation are mandatory to prevent a life-threatening crisis. In both children and adults the infectious aetiology in supraglottitis is predominantly bacterial while viruses are rare, especially in adults. We describe a case of supraglottitis in an adult in which the symptoms were insidious and blood indices suggested a bacterial aetiology. However, laryngoscopic examination revealed an ulcer over the left aryepiglottic fold and serology was positive for Herpes simplex virus (HSV) IgM. Because supraglottitis due to HSV is a rare entity with few reported cases in the literature, this case is presented to highlight the viral involvement in this disease and its management.
