4-year-old female patient from the city of Salto (Uruguay).
Good weight and height development, with personal history of meconium liquid aspiration syndrome, normal growth and development, well immunized and fed.
It begins 4 days before hospital admission with pultaceous, febrile angina, so she is treated with oral clarithromycin.
The day before hospital admission, painful ecchymotic lesions also appear on the external face of the right thigh and on the internal face of the left thigh, with petechial lesions at this level.
The patient was admitted to the Hospital of the city of Salto, where the described hemorrhoidal lesions were found, as well as an ulceronecrotic lesion of the left amygdala, rigidity of the neck and a
A meningococcal meningitis was suspected, and antibiotic therapy was initiated with intravenous ceftriaxone and gentamicin.
Lumbar puncture (LP) was also performed. The result was normal, AELO 400 units, crasis: hypocoagulability with consumption of factors, leukocytosis 15000, plasma sodium 125 meq, potassium 4.5 meq.
Concentrated red blood cells, plasma, cryoprecipitates and platelets are reported. In spite of this, crasis disorders are maintained and there are hemorrhagic sufusions with intense polypnea in both lumbar regions.
Hemorrhagic sufusions are consolidated, with open flictenes and elements of skin necrosis, especially on the external face of both thighs and on the lateral dorsolumbar regions, accompanied by severe pain in this area.
Replacement therapy begins with parenteral hydration, parenteral nutrition and then antibiotic therapy is maintained until bacteriological studies results are obtained; intravenous inotropic support, immunoglobulins with nasal catheter, gastric protection
It is at this stage of evolution when the patient is operated, performing resection of extensive necrotic areas, which exceed in depth what extends on the surface; thus we easily resect partial muscle tissue necrotic of glottis and fascia.
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This procedure is repeated three times, every 48 hours, until a necrotic tissue-free area is left, both in depth and on surface.
The patient begins to improve clinically and paraclinical tests show the result of a blood culture that develops Staphylococcus aureus, so gentamicin is broken by vancomycin.
Focus cultures were negative.
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Subsequently, we fixed anterior plates on areas of loss of donor skin, performing at 7 days the removal of the homoinjectors and their replacement by expanded autoinjectors 2:1 thighs taken from the
The patient was discharged 15 days after admission.
After 6 years of follow-up, she had no further episodes of serious infection in the affected areas or in the rest of her body economy.
