Liang Yujian, He Xiufang, Wang Ti, Chen Yili, Huang Huimin, Tang Wen, Li Yijuan
Department of Pediatrics, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Department of Pediatric Cardiology, Heart Center, The First Affiliated Hospital, Sun Yat-sen University, Guangzhou, China.
Front Pediatr. 2020 May 20;8:254. doi: 10.3389/fped.2020.00254. eCollection 2020.
infection (cdi) often occurs with long-term and irregular use of antibiotics. Patients with tumors receiving both antibiotics and chemotherapy are at a high risk of cdi. The symptoms of cdi vary but can include diarrhea, hypovolemia, electrolyte imbalance, hypoproteinemia, toxic megacolon, gastrointestinal tract perforation, disseminated intravascular coagulation, sepsis, and other lethal complications. Here, we report a rare clinical manifestation associated with cdi in a child with lymphoma presenting with massive hydrothorax and ascites. A 6-year-old girl who was on chemotherapy for lymphoma presented with fever and was treated with intravenous broad-spectrum antibiotics 3 days before admission to our hospital. On the day before admission, she developed abdominal distension and diarrhea. After admission, broad-spectrum antibiotic therapy was initiated, and her hydrothorax and ascites were drained. An initial extensive microbiological evaluation revealed no pathogens, and laboratory tests and imaging studies of the pleural and peritoneal effusions revealed no evidence of cancer. The initial culture results for were negative. The patient was diagnosed with CDI only after a positive test result for toxin B gene and a repeated stool culture test revealed CDI. Intravenous antibiotics were suspended and replaced with oral vancomycin and , which resulted in successful treatment and a good post-discharge outcome. Massive hydrothorax and ascites are rare manifestations associated with CDI. CDI can occur in individuals with risk factors such as those undergoing broad-spectrum antibiotic therapy.
艰难梭菌感染（CDI）常发生于长期不规律使用抗生素的情况下。接受抗生素和化疗的肿瘤患者发生CDI的风险很高。CDI的症状各不相同，但可能包括腹泻、血容量不足、电解质失衡、低蛋白血症、中毒性巨结肠、胃肠道穿孔、弥散性血管内凝血、败血症及其他致命并发症。在此，我们报告1例淋巴瘤患儿发生CDI时出现大量胸腔积液和腹水这一罕见临床表现。1名6岁接受淋巴瘤化疗的女童在入院前3天出现发热，接受了静脉广谱抗生素治疗。入院前1天，她出现腹胀和腹泻。入院后，开始进行广谱抗生素治疗，并对其胸腔积液和腹水进行引流。最初广泛的微生物学评估未发现病原体，对胸腔和腹腔积液进行的实验室检查及影像学研究未发现癌症迹象。最初的 培养结果为阴性。仅在 毒素B基因检测呈阳性且重复粪便培养检测显示为CDI后，该患者才被诊断为CDI。静脉抗生素治疗暂停，改为口服万古霉素和 ，治疗成功，出院后情况良好。大量胸腔积液和腹水是与CDI相关的罕见表现。CDI可发生于有危险因素的个体，如接受广谱抗生素治疗的患者。
