Parmar Parmvir, Feder Joshua, Pham-Huy Anne
Division of Infectious Diseases, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
J Assoc Med Microbiol Infect Dis Can. 2021 Dec 3;6(4):325-329. doi: 10.3138/jammi-2020-0039. eCollection 2021 Dec.
Infections with are especially rare in pediatric patients. is the most common cause of spontaneous myonecrosis and is usually associated with comorbid malignancy. Treatment of choice for cases of myonecrosis is prompt and thorough surgical debridement and antimicrobial therapy with high dose penicillin. The experience and management of infections in patients who are unable to take penicillin are not well described, and the optimal duration of therapy is largely unknown. We describe a case of spontaneous myonecrosis in a 14-year-old receiving cytotoxic chemotherapy for Burkitt's lymphoma who had an anecdotal history of a penicillin allergy. Her infection was initially treated with ceftazidime and metronidazole in concert with debridement but was ultimately cured with 3 weeks of intravenous penicillin therapy following a graded penicillin challenge in hospital. We observed a delayed inflammatory tissue response to a skin, soft tissue infection that temporally corresponded to neutrophil reconstitution in our patient with severe neutropenia. Our experience demonstrates that myonecrosis can present indolently and progress rapidly and highlights the need for clinical vigilance and repeat "second-look" surgeries. Our case also emphasizes the importance of de-labelling penicillin allergies.
[某种感染]在儿科患者中尤其罕见。[某种病菌]是自发性肌坏死最常见的病因，通常与合并恶性肿瘤有关。[某种病菌]性肌坏死病例的首选治疗方法是迅速彻底的手术清创以及大剂量青霉素抗菌治疗。对于无法使用青霉素的患者，[某种病菌]感染的治疗经验和管理方法描述不多，最佳治疗时长也大多未知。我们描述了一例14岁接受伯基特淋巴瘤细胞毒性化疗的患者发生自发性肌坏死的病例，该患者有青霉素过敏史。她的感染最初用头孢他啶和甲硝唑联合清创治疗，但在医院进行分级青霉素激发试验后，最终通过3周的静脉青霉素治疗得以治愈。我们观察到，在严重中性粒细胞减少的患者中，对[某种病菌]皮肤、软组织感染的炎症组织反应延迟，这在时间上与中性粒细胞重建相对应。我们的经验表明，[某种病菌]性肌坏死可能表现隐匿且进展迅速，并强调了临床警惕和重复“二次探查”手术的必要性。我们的病例还强调了去除青霉素过敏标签的重要性。
