ABSTRACT
The Epstein-Barr virus (EBV) is highly prevalent throughout the population. Although in most cases, the infection has a good prognosis, it can cause severe complications. We report a case of a healthy child with a primary EBV infection that evolved with two rare complications. She first presented in the emergency room with fever and sore throat, and was diagnosed with tonsillitis and medicated with antibiotic. She returned 7 days later for fatigue, vomiting and abdominal pain. The examination revealed tonsillitis, swollen cervical lymph nodes and pain in the right hypochondrium. An abdominal ultrasound was performed, compatible with acute acalculous cholecystitis. She was admitted in the paediatric nursery and medicated with intravenous antibiotics. The EBV serology revealed primary infection. Two days later, she developed cardiogenic shock and had to be transferred to an intensive care unit under mechanical ventilation and inotropics. She was discharged 12 days later, keeping a moderate left ventricular dysfunction.
Subject(s)
Cholecystitis, Acute , Epstein-Barr Virus Infections , Tonsillitis , Child , Epstein-Barr Virus Infections/complications , Epstein-Barr Virus Infections/diagnosis , Female , Herpesvirus 4, Human , Humans , Tonsillitis/drug therapy , UltrasonographySubject(s)
Anti-Bacterial Agents/administration & dosage , Syphilis, Congenital/diagnosis , Administration, Intravenous , Female , Humans , Infant, Newborn , Penicillin G/administration & dosage , Pregnancy , Pregnancy Complications, Infectious/diagnosis , Prenatal Care/standards , Syphilis, Congenital/drug therapy , Syphilis, Congenital/physiopathologySubject(s)
Athletic Injuries/complications , Bites and Stings/complications , Epidural Abscess/diagnostic imaging , Foreign Bodies/diagnostic imaging , Scalp/injuries , Adolescent , Anti-Bacterial Agents , Athletic Injuries/microbiology , Athletic Injuries/therapy , Bites and Stings/microbiology , Bites and Stings/therapy , Epidural Abscess/therapy , Fever , Foreign Bodies/complications , Humans , Male , Neuroimaging , Scalp/microbiology , Tooth , Treatment OutcomeABSTRACT
Sinus tachycardia is common in pediatric age, and is usually related to benign physiological conditions, such as somatoform disorders. Nevertheless, it can also be a presenting sign of a disease with an ominous prognosis. We present a case of a previously healthy 15-year-old girl, admitted for syncope. She had been well until one week before admission, when thoracic pain developed. One month prior to the admission she had started oral contraceptives. On examination, she had persistent sinus tachycardia, despite hemodynamic stability and no other associated sign or symptom. Thoracic computed tomography angiography revealed thrombi in the main pulmonary arteries, which confirmed bilateral pulmonary embolism. She was started on anticoagulation with unremarkable clinical course evolution. Pediatric pulmonary embolism is rare, although probably underdiagnosed, given the nonspecific presentation in most cases. Maintaining a high level of clinical suspicion of pulmonary embolism avoids delay in the diagnosis, allows early appropriate treatment and improves prognosis.
A taquicardia sinusal é uma manifestação comum em Pediatria, associada frequentemente a condições fisiológicas, nomeadamente as síndromes de somatização. Pode ser um sinal precoce de patologias graves, com prognóstico adverso. Adolescente de 15 anos, sexo feminino, saudável e sob anticoncetivos orais desde há um mês. Admitida no serviço de urgência por lipotimia. Estava assintomática e não apresentava alterações ao exame objetivo, à exceção de taquicardia sinusal persistente, apesar da estabilidade hemodinâmica. A angio-tomografia computorizada torácica revelou trombos nas artérias pulmonares principais, confirmando o diagnóstico de embolia pulmonar bilateral. Foi iniciada hipocoagulação com boa evolução. A embolia pulmonar em idade pediátrica é rara, embora provavelmente sub-diagnosticada pela apresentação clínica inespecífica, que pode conduzir ao atraso diagnóstico e, consequentemente, agravar o prognóstico.
