Poor soul of vegetable sex, 8-month-old male, with no significant morbid history, with his routine immunizations a day, who had fever managed by his mother with "chicken legs", vomiting (talsis)
After two days of evolution diarrhea was added, presenting twice stools with the appearance of grosella jelly.
Due to the greater commitment of the general state, drowsiness and decay, the mother consulted in the emergency service, where tachycardia, consciousness compromise and slow capillary refill were found, so she was admitted to the Pediatric Antimicrobial Treatment Unit.
She required resuscitation with vasoactive drugs and mechanical ventilation.
The laboratory study at admission showed a complete blood count with leucopenia of 2,000/mm3 (with ANC: 1,000/mm3) associated with left shift (19% of bacilliforms), hematocrit of 23%, platelet count (range 13).
Due to the gastrointestinal involvement a computerized axial tomography (CAT) of the abdomen was performed, where intestinal loops with edema, greater in the sigmoid and free intraabdominal fluid were observed.
Lumbar puncture showed a normal cerebrospinal fluid cytochemical study and brain CT was normal.
CSF culture and coprotiva were negative, urine sample showed sedentarism 4.000 mer/ml Escherichia coli and two hemocultives identified positive at 15 hours vancomycin, cefikazoopenem, ciprofloxacin susceptible.
The patient presented severe septic shock and generalized edema and necrotic lesions in upper and lower extremities with positive culture for P. aeruginosa.
During septic shock, the patient developed disseminated intravascular coagulation, liver test abnormalities and severe thrombocytopenia, requiring multiple transfusions.
Debridement of cutaneous lesions was performed, ruling out bone involvement with magnetic resonance imaging.
He presented with right hand stiffness secondary to tendon compromise due to ichthyomatous lesions.
There was evidence of multiple intraperitoneal perforations.
Due to clinical severity, the antimicrobial regimen was modified to vancomycin and meropenem.
1.
The immunological study performed in order to rule out underlying diseases only showed low C4, which was maintained up to two months after hospital discharge, normalizing in a later control, so it was interpreted as secondary to the septic picture.
The abdominal images showed the presence of the spleen and the rest of the immunological study (total immunoglobulins, lymphocyte subpopulations) was normal; in addition, it exceeded the initial neutropenia, coinciding with the clinical improvement.
