Mycotic pseudoaneurysm secondary to infective endocarditis is an uncommon complication in CHD with conduit placement. We report a case of late presentation of bacterial infective endocarditis with pseudoaneurysm in an 8-year-old girl with underlying pulmonary atresia with ventricular septal defect, post Rastelli procedure done at the age of 3 years old.
Introduction: Necrotizing pneumonia is a rare complication of community-acquired pneumonia. Lung resection is gaining attention as therapeutic alternative in patients who fail to respond to antibiotics. However, we aimed to describe two cases of childhood necrotizing pneumonia successfully managed conservatively. Case Report: MA, a 2-year old boy presented with acute onset respiratory distress with 5 days history of fever and cough. Computed tomography (CT) thorax revealed right pleural effusion with features of necrotizing pneumonia. Despite chest drainage and two weeks of broad-spectrum antibiotic therapy, there was no clinical improvement. Intrapleural urokinase instillation resulted in clinical and radiological improvement. Our second case was NR, an 8-month old girl who presented with acute onset breathing difficulty. CT thorax reported severe left lower lobe necrotizing pneumonia with left hydro-pneumothorax. Ultrasound of left thorax showed presence of left pleural effusion despite nil chest drainage. She improved clinically and radiologically following intrapleural urokinase administration over three days. Conclusion: Intrapleural urokinase may prevent the need of thoracotomy or videoassisted thoracoscopic surgery in necrotizing pneumonia.
This case illustrates acute myocarditis with complete heart block in a 13-year-old teenager as a rare complication of acute dengue illness. He required urgent temporary pacing with inotropic support and antifailure medications. Complete heart block in dengue myocarditis is an acute but reversible condition. A similar presentation in a dengue-endemic country or with a history of travelling to tropical countries warrants a suspicion of dengue infection.
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