Necrotizing Pneumonia in a Diabetic Child Successfully Treated with Pneumonectomy/Pnomonektomi ile Basarili Bir Sekilde Tedavi Edilen Nekrotizan Pnomonili Diyabetik Cocuk

• Published in: Istanbul medical journal 2019-07, Vol.20 (4), p.352
• Main Authors: Atay, Gurkan, Kara, Manolya, Caliskan], Emine, Soysal, Feryal Gun, Torun, Selda Hancerli, Somer, Ayper, Nisli, Kemal, Citak, Agop
• Format: Article
• Language: eng ; tur
• Subjects: Antibiotics; Bacterial pneumonia; Care and treatment; Caspofungin; Diabetes; Diabetes mellitus; Diabetes therapy; Diabetic ketoacidosis; Diabetics; Infection; Lobectomy; Meropenem; Methicillin; Pediatric intensive care; Pediatrics; Pneumonectomy; Pneumonia; Respiratory tract diseases; Staphylococcal infections; Staphylococcus aureus; Staphylococcus aureus infections; Surgery; Teenage girls; Tigecycline
• ISSN: 2619-9793; 1304-8503
• DOI: 10.4274/imj.galenos.2018.33716

Diabetic patients may experience more severe Staphylococcus aureus-related respiratory tract infections such as necrotizing pneumonia (NP). A 13-year-old girl with uncontrolled diabetes mellitus was admitted to pediatric intensive care unit (PICU) with diabetic ketoacidosis and respiratory distress. Her initial evaluation revealed diffuse pneumonic infiltration that progressed to NP within days. She was intubated and placed on mechanical ventilator (MV) support. Positive inotropes and broad-spectrum antibiotics were initiated. Methicillin-resistant S. aureus was isolated from blood and pleural specimen cultures. In spite of aggressive medical treatment, infection could not be controlled and lobectomy was performed. However, the patient was fistulized and right total pneumonectomy was performed on the 16th and 29th days of PICU admission. She gradually got better and was weaned from MV. On the 59th day, she was discharged oxygen-free from the hospital. Early surgical intervention should be considered for the treatment of NP resistant to medical therapy. Keywords: Diabetes, child, necrotizing pneumonia, pneumonectomy Diyabetik hastalar, nekrotizan pnomoni (NP) gibi daha agir seyirli Staphylococcus aureus ile ilgili solunum yolu enfeksiyonlari yasayabilirler. Duzensiz takipli diabetes mellitus tanili 13 yasindaki kiz hasta, diyabetik ketoasidoz ve solunum sikintisi tanilari cocuk yogun bakim unitesine (CYBU) yatirildi. Ilk degerlendirmesinde pnomonik infiltrasyon tespit edilen hasta NP tanisiyla entube edildi ve mekanik ventilator (MV) destegine baglandi. Pozitif inotrop ve genis spektrumlu antibiyotikler baslanildi. Kan ve plevral ornek kulturunde metisiline direncli S. aureus uremesi goruldu. Agresif medikal tedaviye ragmen enfeksiyonu kontrol altina alinamayan hastaya lobektomi yapildi. Fistulize olan ve hayati tehlikesi devam eden hastaya CYBU'ye yatisinin 16 ve 29. gunlerinde sah total pnomonektomi Ameliyatlari yapildi. Kliniginde iyilesme gorulen ve MV'den ayrilan hasta 59. gunde hastaneden oksijensiz taburcu edildi. Medikal tedaviye direncli NP tedavisinde erken cerrahi girisim hayat kurtarici olabilir. Anahtar Kelimeler: Diyabet, cocuk, nekrotizan pnomoni, pnomonektomi