Li Shuang, Huang Guolan, Xie Yongping, Yang Xinghui, Lai Can, Huang Lisu
Department of Infectious Disease, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, People's Republic of China.
Department of Radiology, Children's Hospital of Zhejiang University School of Medicine, National Clinical Research Center for Child Health, National Children's Regional Medical Center, Hangzhou, Zhejiang, People's Republic of China.
Infect Drug Resist. 2024 Nov 28;17:5299-5304. doi: 10.2147/IDR.S478213. eCollection 2024.
Thrombosis is uncommon but increasingly recognized complication in pediatric patients with () infection. In general, small-vessel thrombosis is treated by medication therapy. However, the management of thrombosis in large vessels is more complex and controversial due to the risks of thrombus enlargement and embolization. In this case, we report an 8-year-old boy who was hospitalized for macrolide-resistant pneumonia. After experiencing abdominal pain, he was diagnosed with thrombosis in the pulmonary artery and mesenteric vein. Additionally, massive thrombi were found in the inferior vena cava and left common iliac vein, measuring approximately 4 cm and 4.5 cm in length, respectively. Following routine therapies of anti-infection and anticoagulation, the patient continued to experience recurrent abdominal pain, and there was a risk of the deep vein thrombi detachment. To avoid the shedding of thrombi, the patient underwent inferior vena cava filter placement and catheter-directed thrombolysis with alteplase on day 8 following admission. The clinical symptoms significantly improved, and thrombosis recurrence was not observed in the subsequent follow-ups. This case report highlights the need for prompt recognition of thrombosis in infection. Massive thrombus in deep vein is extremely rare but life-threatening in children. The optimal treatments remain to be determined due to the limited experience to date.
血栓形成在患有（）感染的儿科患者中并不常见，但越来越被认为是一种并发症。一般来说，小血管血栓形成通过药物治疗。然而，由于血栓扩大和栓塞的风险，大血管血栓形成的管理更为复杂且存在争议。在此病例中，我们报告一名8岁男孩因耐大环内酯类肺炎住院。在经历腹痛后，他被诊断为肺动脉和肠系膜静脉血栓形成。此外，在下腔静脉和左髂总静脉发现大量血栓，长度分别约为4厘米和4.5厘米。在进行抗感染和抗凝的常规治疗后，患者仍反复出现腹痛，且存在深静脉血栓脱落的风险。为避免血栓脱落，患者在入院后第8天接受了下腔静脉滤器置入和阿替普酶导管定向溶栓治疗。临床症状明显改善，在随后的随访中未观察到血栓形成复发。本病例报告强调了在（）感染中及时识别血栓形成的必要性。儿童深静脉大量血栓极为罕见但危及生命。由于目前经验有限，最佳治疗方法仍有待确定。
