Síndrome torácica aguda em paciente escolar com doença falciforme: um relato de caso

Abstract

OBJECTIVE: To report the case of a male pediatric patient with acute chest syndrome (ACS) secondary to sickle cell anemia and compare it to other cases reported in medical literature. CASE REPORT: A nine-year-old male child with severe pain associated with headache and priapism was admitted to the emergency department of a tertiary hospital. Priapism improved after hydration and analgesia with morphine. The patient developed severe ACS, pneumonia, and pleural effusion. He was started on cefotaxime, clindamycin, and clarithromycin. The patient required mechanical ventilation and was referred to intensive care. On the tenth day he developed sepsis. Therapy with cefotaxime and clindamycin was discontinued and the patient was prescribed piperacillin/tazobactam and linezolid. He was kept on clarithromycin. On the twelfth day, prophylaxis for pulmonary thromboembolism (PTE) with enoxaparin was introduced due to increased D-dimer. A second PTE was confirmed a few days later. The patient underwent three blood transfusions during hospitalization and improved gradually. He was discharged 36 days after admission and was kept on prophylactic care for thromboembolism until the next follow-up appointment and new tests were ordered. COMMENTS: Infection and PTE were possibly involved in the development of acute chest syndrome. As observed in the literature, pain episodes occurred prior to ACS. The alterations observed in imaging and laboratory tests were consistent with conditions described by other authors. Good diagnosis and treatment led to patient recovery.

Keywords

• anemia
• sickle cell
• priapism
• pulmonary embolism acute chest syndrome children