Abstract:
RATIONALE:This article describes a child with a life-threatening multiorgan failure with disseminated intravascular coagulation (DIC) and massive complement consumption. To our knowledge this therapeutic approach was for the first time effectively applied in a pediatric patient. PATIENT CONCERNS:A 14-month-old boy was presented with a severe, rapidly progressing, life-threatening disease because of sudden onset of fever, hemathemesis, hematuria, and bloody diarrhoea alongside fast spreading hematomas and general corporeal edema. DIAGNOSIS:The most plausible diagnosis in our patient is Clostridium difficile sepsis-induced thrombotic microangiopathy alongside with DIC and consumption coagulopathy. The diagnosis was confirmed by positive C difficile bacteria strain in coproculture, clinical, and laboratory tests affirming DIC and global complement activation and consumption. INTERVENTIONS:The patient was treated with antibiotics (Metronidazole, Vancomycin), plasmapheresis, dialysis, methylprednisolone, mycophenolate mofetil, and Eculizumab. OUTCOMES:The child is in fair overall condition in a 2 year follow-up with no complications save chronic renal failure. LESSONS:In rare cases of sepsis with massive complement consumption, a case-sensitive Eculizumab therapy may be at least considered after the resolution of life-threatening multiorgan failure. The application of this drug can be performed only after sepsis induced disease is put under control. A fast withdrawal of Eculizumab after control of massive complement consumption is recommended to prevent triggering of second sepsis reactivation.
journal_name
Medicine (Baltimore)journal_title
Medicineauthors
Galic S,Csuka D,Prohászka Z,Turudic D,Dzepina P,Milosevic Ddoi
10.1097/MD.0000000000014105subject
Has Abstractpub_date
2019-01-01 00:00:00pages
e14105issue
4eissn
0025-7974issn
1536-5964pii
00005792-201901250-00020journal_volume
98pub_type
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