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Introduction and significance: Chickenpox, induced by the varicella-zoster virus (VZV), generally presents with an itchy rash and fluid-filled blisters. While complications such as pneumonia and sepsis are well-documented, occurrences of septic arthritis and purpura fulminans are exceedingly rare. Septic arthritis following varicella infection is infrequently reported and often attributed to Staphylococcus aureus. Purpura fulminans encompasses disorders characterized by rapidly progressing purpuric lesions, often fatal and associated with consumptive coagulopathy. Case presentation: The authors present the case of an 8-year-old boy diagnosed with chickenpox who concurrently developed severe left knee pain, erythema, and swelling indicative of septic arthritis, along with a single pustular lesion on his right foot that progressed to purpura fulminans. Laboratory investigations revealed elevated inflammatory markers. Knee ultrasound findings were consistent with septic arthritis, corroborated by synovial fluid analysis. Immediate initiation of empiric antibiotics was undertaken. Further investigation disclosed unusual coagulation parameters, positive autoantibodies, and reduced protein S levels. Treatment included anticoagulation, immunomodulation, and ultimately, amputation. Clinical discussion: This rare case underscores the complexity of varicella-related complications, representing the first documented instance of simultaneous septic arthritis and purpura fulminans in a pediatric patient. It highlights the necessity of a multidisciplinary approach for accurate diagnosis and management, emphasizing the importance of recognizing rare complications to improve patient outcomes. Conclusion: This case exemplifies the complexity of varicella-associated complications, showcasing a rare simultaneous occurrence of septic arthritis and purpura fulminans in a pediatric patient. It underscores the importance of a thorough understanding and collaborative management approaches for timely intervention and enhanced clinical outcomes.
RESUMO
Background: congenital pouch colon (CPC) is an extremely rare Congenital gastrointestinal pathology, in which the normal colon is either partially or completely replaced by a pouch-like dilatation communicating with the urogenital tract through a fistula. That's divided into 2 types: Complete CPC and Incomplete CPC. Worldwide and middle east Arabian ethnicity except for Indians, show high scarcity regarding the incidence. Herein, we report a case of incomplete congenital pouch colon syndrome with glandular hypospadias and cardiac anomalies that are considered to be the 2nd documented case in the middle east and the first in Westbank. Case presentation: A 1-day-old newborn boy with prenatal history of abdominal cyst in 2nd trimester US, presented hours after birth with abdominal distention (Fig- 1), in addition to the imperforate anus. The abdominal x-ray showed many dilated bowel loops and gasless soft tissue density with calcifications on the right side (Fig- 2). Exploratory laparotomy was done and showed a pouch-like colon that later on was treated via 2 stages of operation. Clinical discussion: early identification of CPC and differentiation from colon dilatation due to anorectal malformation is essential for the patient's welfare. CPC is more common in males, usually noticed in the neonatal period with abdominal distention, absence of anus, and intestinal obstruction. CPC is managed surgically depending on its type. Conclusion: congenital pouch colon is a rare but important differential diagnosis of abdominal distention, which should always be at the back of the surgeon's mind especially when anorectal malformation is present.