In Turkey, 2009 H1N1 infection caused high mortality and PICU admission due to severe respiratory illness and complications, especially in children with an underlying condition.
Key words abscess, hemorrhage, neonate, suprarenal mass.Adrenal abscess is a rare disease in the neonatal period. Bilateral abscesses are even more uncommon and only a few cases have been reported in the literature. 1,2 In this article, a newborn with bilateral adrenal abscesses as a complication of adrenal hemorrhage is reported. Case reportA full-term male neonate was born in our hospital with a birthweight 3920 g. It was the first pregnancy and the first delivery of the mother. No problem was noted during the pregnancy, but during the perinatal period fetal distress occurred and the infant was delivered by cesarean section. He underwent resuscitation in the delivery room because of depressed respiration. The laboratory findings on the first day of life were as follows: hemoglobin 16.5 g/dL, hematocrit 49.3%, lactate dehydrogenase 1992 U/L and creatine kinase 1816 U/L. He suffered from perinatal asphyxia and was treated with oxygen in the neonatal intensive care unit for 3 days. He had hyperbilirubinemia and received phototherapy for a short period and then he was discharged on the 7th day in good condition. However, 3 days later, when he was 10 days old, he came back with profound jaundice. The unconjugated bilirubin level was 26.9 mg/dL and his hemoglobin level was 11.4 g/dL. He was treated with phototherapy again. White blood cells, platelet count, clotting tests, renal and hepatic functions, blood glucose and electrolytes were in the normal range but his C-reactive protein level was elevated (129 mg/dL) and there was no evidence of hemolysis. Because of severe hyperbilirubinemia and anemia, an internal hemorrhage was suspected and ultrasonographic examination was performed. Abdominal ultrasonography revealed bilateral adrenal cystic masses measuring 55 ¥ 41 ¥ 54 mm at the left and 61 ¥ 45 ¥ 58 mm in the right suprarenal fossa. The masses were well-circumscribed, roundshaped cystic lesions that contained internal mobile echoes and caused distal acoustic enhancement in the suprarenal space bilaterally. Adrenal hemorrhage was considered as the cause of the masses. Doppler ultrasonography (Fig. 1) and abdominal computed tomography (Fig. 2) confirmed the adrenal hematoma. To exclude a hemorrhagic neoplastic process such as neuroblastoma, neuron-specific enolase and 24-h urinary excretion of vanillylmandelic acid were measured and ultrasound-guided needle aspiration was performed. Neuron-specific enolase and vanillylmandelic acid levels were within the normal ranges, hemorrhagic and purulent material was aspirated from both sides and no neoplastic cells were found on microscopic examination. Pus was drained with percutaneous catheterization of the abscess and cultures were positive for Proteus mirabilis. Percutaneous drainage was continued for 10 days and, according to the antibiogram, the infant was treated with ceftriaxon plus netilmicin for 15 days. The second culture following antibiotic treatment was negative. During his stay in the hospital our patient did not suffer from fever, septic findings or feeding d...
Although appropriate use of antibiotics has decreased mortality, lateral sinus thrombosis is a rare, important intracranial complication of acute otitis media. Herein is described the case of a 5-year-old patient with lateral sinus thrombosis after acute otitis media. We emphasize the need to be alert for lateral sinus thrombosis when treating acute otitis media.
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