Sudden Death of a Child Who Had Pain in the Knee and Varicella. A Case Report*

Hamner, Dyson L.; Lyon, Richard H.; Emans, John B.

doi:10.2106/00004623-199604000-00015

Cited by 4 publications

(4 citation statements)

References 12 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Sudden deterioration of her condition points towards pulmonary thrombo embolism; another well known complication of septic arthritis [5]. On the other hand, septic pulmonary embolism is a reported complication and needs to be considered as a cause for her sudden onset of dyspnoea and death within few hours [6]. Local spread of the infection can lead to septic thrombophlebitis of the adjacent deep veins.…”

Section: Discussionmentioning

confidence: 99%

A case of sudden death due to septic pulmonary embolism

Kitulwatte¹,

Wijerathna²

2014

Medico-Legal J SL

View full text Add to dashboard Cite

Introduction: Sudden deaths in hospital following a short duration of seemingly improving illness arouse suspicion of medical maltreatment. It is mandatory to have a medico-legal investigation in to such deaths. Facts, explanations, and opinions made by the forensic pathologists at the end of an autopsy examination are of crucial importance to eliminate or confirm such doubts. We report how a thorough autopsy examination including ancillary testing can lead to effective administration of justice in such cases.Case History: A 42 year woman with diabetes mellitus was admitted to hospital with fever and right knee joint swelling and tenderness of one week's duration. There was cellulitis over the right knee joint and underlying septic arthritis. Surgical drainage of the joint was done and intra venous antibiotics were given and the condition seemed to be improving. On the 4 th day of admission, she developed sudden onset of shortness of breath and central chest pain resulting in death 12 hours later. At autopsy she was pale and icteric. There was evidence of septic arthritis with surrounding necrotizing fasciitis and deep venous thrombosis of the right calf. There was consolidation of the right lung with patchy focal pale yellow areas with surrounding erythema, and evidence of multi-organ sepsis. Microscopy confirmed multi organ involvement and revealed pneumonia of the right lung with early abscess formation and multiple bilateral peripheral septic thrombo emboli. There was septic thrombosis of the calf veins with associated thrombo phlebitis. Conclusion:Facts revealed at autopsy explained the sudden death and the possibility of such death was scientifically clarified. The cause of death was concluded as septic pulmonary thrombo embolism due to deep venous septic thrombosis and thrombophlebitis due to septic arthritis and necrotizing fasciitis.

show abstract

Section: Discussionmentioning

confidence: 99%

A case of sudden death due to septic pulmonary embolism

Kitulwatte¹,

Wijerathna²

2014

Medico-Legal J SL

View full text Add to dashboard Cite

show abstract

“…Schreck et al 9 calculated the approximate rate of one musculoskeletal complication for every 10,000 (0.01%) paediatric varicella cases. Several authors have reported a variety of post-varicella-associated musculoskeletal sequelae, including purpura fulminans, 16 septic arthritis, 8,9,17–20 osteomyelitis, 5,6,9,10,21–25 deep-tissue abscess, pyomyositis 9,25 and necrotizing fasciitis. 7,9,25 Patients with necrotizing fasciitis or pyomyositis often develop life-threatening complications of TSS.…”

Section: Discussionmentioning

confidence: 99%

“…2–4 Although rare, musculoskeletal sequelae (osteomyelitis, septic arthritis, pyomyositis and necrotizing fasciitis) can occur in otherwise healthy children. 5–10 These complications are potentially life- and limb-threatening and must be considered post-varicella if there is pain in a limb or joint. 5,6…”

Section: Introductionmentioning

confidence: 99%

Musculoskeletal sequelae of Varicella-zoster infection: two case reports

Lim

Huntley

2012

Scott Med J

View full text Add to dashboard Cite

Varicella-zoster is a common paediatric viral infection that usually runs a benign self-limiting course but has a risk of complications. The most common sequelae are bacterial skin infections, which are usually mild. However, bacteraemia/septic shock, toxic shock syndrome, pneumonia, ataxia, encephalitis and purpura fulminans are also possible. Although rare, musculoskeletal sequelae (osteomyelitis, septic arthritis, pyomyositis and necrotizing fasciitis) can occur in otherwise healthy children. These latter complications are potentially life- and limb-threatening and must be considered in a child post-varicella with pain in a limb or joint. We describe two patients who had musculoskeletal complications after varicella: (1) a 16-month-old boy who developed pyomyositis of the thigh and septic arthritis of the hip and (2) a two-year-seven-month-old girl who developed septic arthritis of the hip and knee and a 'bare area' subperiosteal abscess of the femur. Their clinical presentations, detailed management plans and outcomes are reported. These cases highlight the importance of prompt diagnosis, appropriate investigation (including the important role of magnetic resonance imaging) and surgery when an otherwise healthy post-varicella child deteriorates.

show abstract

“…Notably, many reports document concurrent infections with two or more of these agents (e.g. Rahal et al 1968, Hamner et al 1996, Kouwabunpat et al 1999, Sakata et al 1999.…”

Section: Case Study: Idiopathic Thrombocytopenia Purpuramentioning

confidence: 99%

Antigenic Complementarity in the Origins of Autoimmunity: A General Theory Illustrated With a Case Study of Idiopathic Thrombocytopenia Purpura

Root‐Bernstein

Couturier

2006

Journal of Immunology Research

View full text Add to dashboard Cite

We describe a novel, testable theory of autoimmunity, outline novel predictions made by the theory, and illustrate its application to unravelling the possible causes of idiopathic thrombocytopenia purpura (ITP). Pairs of stereochemically complementary antigens induce complementary immune responses (antibody or T-cell) that create loss of regulation and civil war within the immune system itself. Antibodies attack antibodies creating circulating immune complexes; T-cells attack T-cells creating perivascular cuffing. This immunological civil war abrogates the self -nonself distinction. If at least one of the complementary antigens mimics a self antigen, then this unregulated immune response will target host tissues as well. Data demonstrating that complementary antigens are found in some animal models of autoimmunity and may be present in various human diseases, especially ITP, are reviewed. Specific mechanisms for preventing autoimmunity or suppressing existing autoimmunity are derived from the theory, and critical tests proposed. Finally, we argue that Koch's postulates are inadequate for establishing disease causation for multiple-antigen diseases and discuss the possibility that current research has failed to elucidate the causes of human autoimmune diseases because we are using the wrong criteria.

show abstract

Sudden Death of a Child Who Had Pain in the Knee and Varicella. A Case Report*

Cited by 4 publications

References 12 publications

A case of sudden death due to septic pulmonary embolism

A case of sudden death due to septic pulmonary embolism

Musculoskeletal sequelae of Varicella-zoster infection: two case reports

Antigenic Complementarity in the Origins of Autoimmunity: A General Theory Illustrated With a Case Study of Idiopathic Thrombocytopenia Purpura

Contact Info

Product

Resources

About