Pseudomonas aeruginosa endocarditis in a 3-Year-old boy treated for acute lymphoblastic leukemia
(2009) 27th Annual Meeting of the European Society for Paediatric Infectious Diseases — Location: Brussels (9.June.2009)
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- Abstract
- Background: Pseudomonas aeruginosa has been described as an uncommon cause of endocarditis in adults but to our knowledge no pediatric case has been reported in the literature for the past 20 years. Clinical case: We describe a 3-year-old boy diagnosed with acute lymphoblastic leukemia who first developed a fully susceptible Pseudomonas aeruginosa bacteremia while he was in neutropenia. An initial antibiotherapy was started using piperacillintazobactam and amikacin. Recurrent bacteremias occurred during the following 101 days despite central venous access device replacements and multiple courses of antibiotics, including meropenem, ceftazidime, ciprofloxacin, rifampicin and colimycin. Several cardiac ultrasound were performed but evidence of endocarditis was observed only after 60 days of bacteremia when both transoesophageal and transthoracic ultrasound showed the rupture of a tricuspid cord and the presence of a millimetric image on the atrial side of the tricuspid valve. Due to failure of medical treatment, cardiac surgery was performed. Peroperative findings confirmed a purulent granuloma and perforations on the tricuspid valve.The abcess was removed and the valve repaired. The valvular biopsy yielded Pseudomonas aeruginosa. Antibiotics were extended for 30 days after surgery with no further positive blood cultures at 5 months of follow-up. Conclusion: Pseudomonas aeruginosa is an exceptional cause of endocarditis in children. Prompt removal of central venous device should be performed in case of Pseudomonas aeruginosa bacteremia. Surgical intervention must be considered without delay if not responding to targeted antibiotics, particularly in leukemic patients with a greater risk of negative impact on their hematological outcome.
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Citations
André, E., Moniotte, S., Huang, T.-D., Rubay, J., Brichard, B., Chantrain, C., Dupont, S., Vermylen, C., & Van der Linden, D. (2009). Pseudomonas aeruginosa endocarditis in a 3-Year-old boy treated for acute lymphoblastic leukemia. The Pediatric Infectious Disease Journal, 28(6), 560-e258. https://hdl.handle.net/2078.5/218682 (Original work published 2009)