Child neglect followed by marked thymic involution and fatal systemic pseudomonas infection

Abstract

The case of a 9-month-old baby girl who failed to develop normally due to nutritional neglect and secondary immunodeficiency characterized by marked thymic involution is reported. The child died of systemic Pseudomonas aeruginosa (P. aeruginosa) infection manifested in pneumonia, lung abscesses, bacterial endocarditis and ecthyma gangrenosum. At autopsy the child was 64 cm in height (normal for a 4- to 5-month-old child) and 5.1 kg in weight (normal for a 2- to 3-month-old child). Multiple gangrenous ecthymas, consisting of deep ulcers, induration and inflammation, were observed in the skin over the entire body. The lungs showed hemorrhagic pneumonia, multiple lung abscesses, and necrotizing arteritis in the abscesses and surrounding areas. The thymus weighed 2.3 g and showed marked involution. Histological examination showed so-called nutritional thymectomy characterized by severe cortical atrophy and clustering, cystic dilation and amorphous changes of the Hassall's corpuscles. In the heart, dark brown verrucae were present at the attachment sites of the tendinous cords of the papillary muscle in the anterior and posterior cusps of the mitral valve, suggesting infectious endocarditis. Bacteriological examination demonstrated P. aeruginosa in the ecthymas, lung abscesses and blood. As primary immunodeficiency was considered unlikely, immunodeficiency secondary to thymic involution following malnutrition seemed to have led to a fatal systemic infection with P. aeruginosa, whose virulence is generally weak. This suggests a close association of the development of such infection and immunodeficiency with child neglect.

Child abuse followed by fatal systemic Pseudomonas aeruginosa infection

“…Previous publications have reported thymic involution due to child abuse in cases with ages ranging from a little more than 1 month to 6 years and in two cases a P. aeruginosa infection was involved [3][4]6,14]. In the case that we are reporting, the boy was 7 years and 4 months old and a P. aeruginosa infection caused sepsis, acute respiratory distress syndrome, intravascular coagulation, multiple organ failure and finally, death.…”

“…As a result, the CD4 + CD8 + double positive thymocytes decrease in number and therefore the thymus begins an involution process, which depresses cell-mediated immunity [3]. Thymic involution, i.e., decreased thymic weight and volume, has been reported in cases of child abuse [3][4][5][6], drug abusers [7] and in elder abuse, although the latter can be masked by age-associated thymic fatty replacement [8]. This thymic atrophy has also been described as ''nutritional thymectomy'' [4] because it is often caused by nutritional disturbances.…”

Child deaths with persistent neglected experiences from medico‐legal documents in Japan

“…In addition to the insufficient reporting system, the number of studies on fatal child neglect is also limited in Japan. Although neglect is difficult to define and measure, to our knowledge only seven articles were available from PubMed (by searching with “child neglect” and “autopsy” and “Japan”); and three articles from Igaku Chuou Zasshi , the Japanese database for medical articles (by searching with “child neglect” and “autopsy” and “death” in Japanese and by hand‐searching). The majority were case reports, and there was neither systematic evaluation nor classification of child fatal neglect so far.…”

Violência contra a criança: indicadores dermatológicos e diagnósticos diferenciais

“…Attention should be given to repetitive episodes of pyoderma that can be caused by bad hygiene, indicating child neglect. 59 c) Staphylococcal scalded skin syndrome: it can mistaken for intentional scalding of children. [60][61][62] In the hospital, if the appearance of new bullous lesions is observed, natural causes can be confirmed.…”