Pediatric thymic atrophy with malnutrition and opportunistic lung infection: A case report

Abstract

Introduction: Pediatric infectious disease mortalities are common in sub-Saharan Africa. Autopsies are rarely performed because these are usually classified as natural mortalities. Because of recent legislation requiring autopsies in deaths occurring within 24 h of admission into health care facilities and deaths in foster care homes, these autopsies will be more common in forensic pathology practise. Pediatric infectious disease mortalities are frequently associated with severe malnutrition. We present a case of pediatric lung disease mortality encountered in a forensic pathology practice, referred because the child was a resident of a children’s home. Case report: We present a case of a 2-month-old male infant who died due to acute infectious lung disease. He presented with clinical features of pneumonia and malnutrition. There was no history of abuse, however, the care givers were concerned about failure to thrive and poor feeding. Autopsy findings showed features of severe acute malnutrition, acute lung injury characterized by exudative diffuse alveolar damage and organisms morphologically consistent with pneumocystis carinii pneumonia. There was severe thymic atrophy. On enquiry, livestock (chicken and ducks) were also reared within the institution. Conclusion: Environmental exposure to livestock appears to have contributed to pneumocystis infection while malnutrition and failure to thrive are the main susceptibility factors. Thymic atrophy is a common finding in these autopsies and may be causally related with secondary immune deficiencies. Identification of these causes of death in a forensic pathology practice may provide evidence needed to improve safety of institutionalized infants and children. Keywords: Pediatric pneumonia, Thymus, Malnutrition, Autopsy