Souza Tiago Henrique de, Nadal José Antônio, Lopes Carlos Eduardo, Nogueira Roberto José Negrão
Universidade Estadual de Campinas, Campinas, SP, Brasil.
Rev Paul Pediatr. 2019 Jan-Mar;37(1):126-129. doi: 10.1590/1984-0462/;2019;37;1;00009. Epub 2018 Aug 30.
To report a rare case of a child with invasive pneumococcal disease that presented meningitis associated with pericarditis.
This report describes the unfavorable clinical course of a previously healthy 6-months-old female infant who initially presented symptoms of fever and respiratory problems. A chest X-ray revealed an increased cardiac area with no radiographic changes in the lungs. After identifying a pericardial effusion, the patient experienced seizures and went into coma. Pneumonia was excluded as a possibility during the clinical investigation. However, Streptococcus pneumoniae was identified in the cerebrospinal fluid and blood cultures. An initial neurological examination showed that the patient was brain dead, which was then later confirmed according to protocol.
Purulent pericarditis has become a rare complication of invasive pneumococcal disease since the advent of antibiotic therapy. Patients with extensive pneumonia are primarily predisposed and, even with early and adequate treatment, are prone to high mortality rates. The association of pneumococcal meningitis and pericarditis is uncommon, and therefore difficult to diagnose. As such, diagnostic suspicion must be high in order to institute early treatment and increase survival.
报告一例罕见的侵袭性肺炎球菌病患儿，其表现为脑膜炎合并心包炎。
本报告描述了一名此前健康的6个月大女婴的不良临床病程，该患儿最初出现发热和呼吸问题症状。胸部X线显示心脏面积增大，肺部无影像学改变。在发现心包积液后，患者出现癫痫发作并陷入昏迷。临床调查期间排除了肺炎的可能性。然而，脑脊液和血培养中发现了肺炎链球菌。初步神经系统检查显示患者脑死亡，随后根据规程得到确认。
自抗生素治疗出现以来，化脓性心包炎已成为侵袭性肺炎球菌病的罕见并发症。广泛肺炎患者是主要易感人群，即使早期进行充分治疗，也容易出现高死亡率。肺炎球菌脑膜炎和心包炎的关联并不常见，因此难以诊断。因此，必须高度怀疑诊断，以便尽早治疗并提高生存率。
