1 - Paediatrics, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
2 - Paediatric Radiology Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
3 - Paediatric Surgery Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
4 - Pathology Department, Hospital São José, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
5 - National Institute of Health Dr Ricardo Jorge (INSA), Lisbon, Portugal.
6 - Infectious Diseases Unit, Hospital Dona Estefânia, Centro Hospitalar Universitário Lisboa Central, Lisbon, Portugal.
- E-poster, 39th Annual Meeting of the European Society for Paediatric Infectious Diseases (ESPID)
Resumo
Association with viral infection has been reported. CASE PRESENTATION SUMMARY A 4-month-old male was admitted to our hospital with a 24-hour history of febrile illness, irritability, non-bloody loose stools, poor feeding and vomiting. He was a late preterm (35 weeks) born from a twin pregnancy without perinatal complications. He had received a second dose of RV vaccine the day before (18 weeks of age) and had a 3 years-old sister with coryza. On physical examination, he looked ill, had fever (39ºC), heart rate of 174 bpm, respiratory rate of 20 breaths/min. The abdomen was distended with diminished bowel sounds. The white cell count was 9 780/μL (neutrophils 6650/μL) and a C reactive protein (CRP) of 263 mg/dL. He had pyuria (96 leucocytes/μL) and a positive nasopharyngeal respiratory syncytial virus (RSV). The ultrasonography showed a dilated appendix (9 mm), enlarged adjacent mesenteric lymph nodes and a thin layer of hyperechogenic free-fluid. The laparotomy revealed a perforated retrocecal appendix with an appendicular abscess and appendicectomy was performed. Histopathology confirmed the diagnosis and revealed glandular atrophy and corion fibrosis of the mucosa compatible with an ischemic aetiology. Reverse transcription-polymerase chain reaction and immunohistochemistry to detect RV is being processed. Stools weren´t available for testing. He completed 7 days of intravenous antibiotics with an uneventful recovery, besides a VSR bronchiolitis at day 5.
LEARNING POINTS/DISCUSSION In our patient, one could theorize that lymphoid hyperplasia after a viral infection, RV or even RSV, determined appendicular luminal obstruction, or that an ischemic event, in particular an intermittent intussusception after RV vaccine, could have resulted in wall oedema and obstruction.
Palavras Chave: Acute appendicitis; Rotavirus; Immunization