Article Text

JAUNDICE, UNREMITTING HYPERPYREXIA, HAEMATURIA AND IMPENDING SHOCK IN A 16 YEAR OLD BOY
  1. D M Chan1,
  2. M O Chan1
  1. 1Department of Pediatrics, Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada

Abstract

Objective To demonstrate the successful salvage of a 16 year old boy suffering from multiple organ failure, severe sepsis with impending Gram negative shock with aggressive combination antibiotic treatment.

Method Case presentation: A 16 year old boy returning from India presented with a five day history of unremitting fever up to 41°C, non-responsive to treatment with amoxacillin and clavulanic acid, becoming severely lethargic, jaundiced and passing haematuria. Initial laboratory tests showed a WBC of 29000, platelet of 467,000, marked neutrophilia. Bilirubin up, 80 mg/l, and indirect bilirubin 64 mg/l. G6PD assay down to 0.7, significantly deficient and ASOT over 1500. C reactive protein was 1700. Haemolysis with marked haematuria was noted. Chest X ray showed bilateral bronchopneumonia. Blood culture positive of Salmonella typhi and sputum culture positive of Haemophilus influenzae and group G streptococci. The patient was suffering from bloody diarrhoea, reducing urine output, tachycardia with heart rate close to 170 and deminishing urine output. Physical examination revealed a boy in impending shock, with chills and rigors, excessive sweating and high fever.

Results Aggressive salvage treatment: IVIG 20 grams given together with normal saline in 5% dextrose, IV tigecycline 100 mg and linezolid 600 mg, given simultaneously with dexamethasone 12 mg IV. He was completely afebrile. IV linezolid was discontinued after 36 hours with immediate resurgence of fever. Tigecycline was not sufficient to control the Gram positive sepsis. Reintroduction of linezolid induced immediate response.

Conclusion 7 days of resistance defensive antibiotics is life saving.

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