Introduction: Henoch-Schönlein purpura (HSP) is the most common vasculitis of childhood. The classic triad of HSP consists of nonthrombocytopenic purpura, arthritis/arthralgia, and gastrointestinal complaints. Pulmonary hemorrhage and cardiac involvement are rare complications of HSP. Case Report: We report the case of a 10-year-old girl with HSP complicated by both severe mitral regurgitation and pulmonary hemorrhage. Discussion: HSP is typically a self-limited illness with an excellent prognosis in children. Pulmonary hemorrhage is a rare complication that increases morbidity and mortality; it generally indicates the presence of severe vasculitis. Cardiac involvement in HSP is extremely rare and associated with a poor prognosis. Conclusion: Cardiac involvement in HSP may be more common than believed. Because of the increased morbidity and mortality associated with HSP complicated by pulmonary hemorrhage and cardiac involvement, it is important for clinicians to be aware of these potential complications.
Post-extubation respiratory failure requiring reintubation in a Pediatric Intensive Care Unit (PICU) results in significant morbidity. Data in the pediatric population comparing various therapeutic respiratory modalities for avoiding reintubation is lacking. Our objective was to compare therapeutic respiratory modalities following extubation from mechanical ventilation. About 491 children admitted to a single-center PICU requiring mechanical ventilation from January 2010 through December 2017 were retrospectively reviewed. Therapeutic respiratory support assisted in avoiding reintubation in the majority of patients initially extubated to room air or nasal cannula with high-flow nasal cannula (80%) or noninvasive positive pressure ventilation (100%). Patients requiring therapeutic respiratory support had longer PICU LOS (10.92 vs 6.91 days, P-value = .0357) and hospital LOS (16.43 vs 10.20 days, P-value = .0250). Therapeutic respiratory support following extubation can assist in avoiding reintubation. Those who required therapeutic respiratory support experienced a significantly longer PICU and hospital LOS. Further prospective clinical trials are warranted.
Objective: To report a case of priapism in an adolescent male following the use of propofol for sedation. Case Report: A 13-year-old male with developmental delay was admitted to intensive care secondary to pneumonia and persistent paroxysmal choreoathetosis. In attempt to stop the choreoathetosis and progressive rhabdomyolysis, he was sedated with 50 mg of intravenous propofol, which successfully resolved the choreoathetosis. Within minutes after the injection, he developed priapism, and within 1 hour it resolved without intervention. Discussion: Priapism was considered to be caused by propofol based on temporal relationship, lack of other medications administered, and complete resolution of symptoms after withdrawal. An objective causality assessment based on the Naranjo adverse drug reaction probability scale suggests propofol is a probable cause of the priapism in our patient. The mechanism of propofol-induced priapism is unknown but likely occurs due to both local and systemic effects. Conclusion: Pediatric clinicians should be aware of this rare side effect, as it requires prompt recognition and potential urologic intervention to alleviate complications.
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