Jaish Majed Abu, Akila Mai, AlHabil Yazan
Department of Pediatrics, Arab Women's Union Hospital, Nablus, Palestine.
Department of Human Medicine, Faculty of Medicine and Health Sciences, An-Najah National University, Nablus, Palestine *Email:
Qatar Med J. 2024 Nov 11;2024(4):67. doi: 10.5339/qmj.2024.67. eCollection 2024.
The introduction of the varicella vaccine has led to a significant decrease in pediatric varicella-induced invasive (group A streptococcal [GAS]) infections. However, the development of a pleural empyema following a chickenpox infection is a rare complication in pediatric patients.
In this report, we present a 5-year-old male patient who presented to the emergency department with a deteriorating course two days after a chickenpox infection. The patient complained of high-grade documented fever, a congested throat, abdominal pain, shortness of breath, and most importantly, decreased air entry on the right side of the chest, along with the presence of crepitations. Such a deteriorated clinical picture suggested the presence of an infectious cause. The patient's physical examination and radiological imaging provided evidence for the presence of lower right-sided lobar pneumonia. On the second day of hospitalization, the patient showed worsening respiratory distress, prompting further investigations that confirmed the development of a right-sided pleural empyema through radiological imaging. Pediatric surgery consultation was requested, and 500 cc of pus was drained following the insertion of a chest tube, which was later sent for analysis. The patient's clinical picture improved significantly following this intervention. Due to the severity of his condition, the patient was transferred to the pediatric intensive care unit (PICU) for close monitoring. After one night in the PICU, during which his condition stabilized and oxygen therapy was gradually weaned off, the patient continued to improve on the general ward. Daily assessments and laboratory tests showed decreasing inflammatory markers and resolution of symptoms. Following three days of admission and confirmation of no underlying immunologic deficiency, the patient was discharged home with appropriate antibiotic therapy and follow-up instructions.
Similar cases have been sporadically documented in pediatric literature, with notable examples involving older patients. The pathophysiology involves complex immune interactions and virulence factors of GAS, contributing to severe outcomes such as pleural effusion.
In this case, the 5-year-old patient experienced a severe progression from chickenpox to pleural empyema but ultimately improved following prompt medical intervention and chest tube drainage. The patient was discharged after a successful recovery, highlighting the efficacy of early recognition and treatment in managing such complications.
水痘疫苗的引入已导致小儿水痘引起的侵袭性（A组链球菌[GAS]）感染显著减少。然而，水痘感染后发生胸膜腔积脓在儿科患者中是一种罕见的并发症。
在本报告中，我们介绍了一名5岁男性患者，他在水痘感染两天后病情恶化，前往急诊科就诊。患者主诉有记录的高热、喉咙充血、腹痛、呼吸急促，最重要的是，右侧胸部呼吸音减弱，并伴有捻发音。如此恶化的临床表现提示存在感染性病因。患者的体格检查和影像学检查为右下叶肺炎的存在提供了证据。住院第二天，患者呼吸窘迫加重，促使进一步检查，通过影像学检查证实右侧胸膜腔积脓。请求小儿外科会诊，插入胸管后引出500毫升脓液，随后送去分析。经过此干预后，患者的临床表现显著改善。由于病情严重，患者被转至小儿重症监护病房（PICU）进行密切监测。在PICU度过一晚后，患者病情稳定，逐渐停用氧疗，之后在普通病房继续好转。每日评估和实验室检查显示炎症指标下降，症状缓解。入院三天且确认无潜在免疫缺陷后，患者接受适当的抗生素治疗并得到随访指导后出院回家。
儿科文献中曾零星记录过类似病例，其中值得注意的例子涉及年龄较大的患者。其病理生理学涉及GAS复杂的免疫相互作用和毒力因子，导致诸如胸腔积液等严重后果。
在此病例中，该5岁患者从水痘严重进展为胸膜腔积脓，但最终经及时的医疗干预和胸管引流后好转。患者康复成功后出院，突出了早期识别和治疗此类并发症的有效性。
