Trombosis de vena cava inferior y endocarditis en un paciente prematuro: Caso clínico

Abstract

inferior vena cava thrombosis and endocarditis in a premature patient -Case reportThrombosis of the inferior vena cava represents a significant percentage of all venous thrombosis that take place during the neonatal period, generally associated with risk factors such as the use of central venous catheter. The incidence of bacterial endocarditis in preterm infants is low. objectives: To characterize the case of a preterm neonate with both conditions and to detail the disease changing spectrum in the neonatal population and its therapeutic possibilities. Case report: Premature newborn, 31 + 5 weeks of gestation who presented Enterococcus faecalis bacteremia, developed progressive thrombosis of the inferior vena cava and right atrium secondary to the use of umbilical venous catheter, with subsequent diagnosis of endocarditis. He was treated with anticoagulation with subcutaneous low molecular weight heparin. Given a favorable evolution, it was decided to continue the anticoagulation therapy for 4-6 weeks, and at the time of discharge, aspirin treatment was given. Conclusions: The preterm infant with infective endocarditis and intracardiac thrombus presents an interesting management dilemma. Treatment should be individualized according to the clinical evolution and safety profile of thrombolytic and/or anticoagulant agents. Availability and advantages of low molecular weight heparin have led to its use as an alternative treatment in neonates and infants with deep venous thrombosis. (Key words: Neonatal bacteremia, central venous catheter, endocarditis, thrombosis). Rev Chil Pediatr 2014; 85 (6): 708-713 resumen La trombosis de la vena cava inferior corresponde a un porcentaje importante de las trombosis venosas en la etapa neonatal, generalmente asociado a factores de riesgo como el uso de catéter venoso central. La incidencia de endocarditis bacteriana en recién nacidos prematuros es baja. objetivos: Caracterizar el caso de un neonato pretérmino en que se asociaron ambas patologías y detallar el espectro cambiante de esta enfermedad en la población neonatal y sus posibilidades terapéuticas. Caso clínico: Recién nacido prematuro de 31 + 5 semanas de gestación, que presentó bacteriemia por Enterococo faecalis, evolucionó con trombosis progresiva de la vena cava inferior y aurícula derecha secundaria al uso de catéter venoso umbilical, con posterior diagnóstico de endocarditis. Se manejó con anticoagulación con heparina de bajo peso molecular en forma subcutánea, CASO CLíNICO Rev Chil Pediatr 2014; 85 (6): 708-713

Inferior vena cava thrombosis with septic shock case report and literature review

“…IVCST is an uncommon condition that is often associated with surgical procedures, implantation of vascular foreign bodies, intravenous drug use, and tumor invasion [1][2][3][4][5][6][7] . In one reported case, the condition was secondary to Crohn's disease 8 .…”

“…In the course of the disease, different pathogens may be cultured at different times in the same patient. Reported cases have identi ed bacteria such as Enterococcus, Staphylococcus, Streptococcus, Klebsiella, Bacteroides, Actinomyces, and Enterobacteriaceae coli, as well as Candida as the most common gram-positive bacteria and fungi, respectively [1][2][3][4][5][6][7][8] . Buitrago AP et al reported a case of an infant with IVC thrombosis and infective endocarditis (IE) resulting from umbilical vein catheterization 5 .…”

“…Recurrence of septic thrombophlebitis may be in uenced by diabetes 4 . Pathogens causing IVCST can vary and include both bacteria and fungi [1][2][3][4][5][6][7][8] . In the course of the disease, different pathogens may be cultured at different times in the same patient.…”

“…Reported cases have identi ed bacteria such as Enterococcus, Staphylococcus, Streptococcus, Klebsiella, Bacteroides, Actinomyces, and Enterobacteriaceae coli, as well as Candida as the most common gram-positive bacteria and fungi, respectively [1][2][3][4][5][6][7][8] . Buitrago AP et al reported a case of an infant with IVC thrombosis and infective endocarditis (IE) resulting from umbilical vein catheterization 5 . Another case reported by Işik M et al described IVC thrombus in patients originating from intestinal diverticulum perforation, accompanied by IE.…”

“…The use of anticoagulants in septic thrombophlebitis is still a subject of controversy. Most studies employ heparin and warfarin for anticoagulation [1][2][5][6][7] . Brown CE et al compared the prognosis of patients with pelvic septic thrombophlebitis treated with and without heparin and found no signi cant differences in fever duration and hospital stay between the two groups.…”