Grand Rounds

Staphylococcus Aureus Infection and Internal Jugular Vein Thrombophlebitis


Ira Shah, Shakil Shaikh, Vijay Raut
Department of Pediatrics, B J Wadia Hospital for Children.

Address for Correspondence: Dr Shakil Shaikh, Department of Pediatrics, B J Wadia Hospital for Children, Mumbai, India. Email: drshakilsshaikh@rediffmail.com


Clinical Problem:
Case Report: A 10 month old male child was referred in view of fever, anasarca and respiratory distress. He was treated with ceftriaxone by referring hospital for 3 days. On presentation to us, he had pallor, was lethargic with heart rate of 140/minute, respiratory rate of 50/minute, had poor peripheral pulses with hypotension. He also had blackish lesion over right great toe and left facial nerve palsy. He was given intravenous fluid boluses and was shifted to intensive care unit for management of septic shock. He was ventilated for respiratory failure and required inotropic support also. Initial investigations showed thrombocytopenia and high CRP of 192 mg/l. Other blood investigations were unremarkable. He was initially started on ceftriaxone, cloxacillin and clindamycin as blood culture grew methicillin sensitive staphylococcus aureus. But fever persisted and he had two episodes of generalised tonic clonic convulsions on day 6 of antibiotics. Cerebrospinal fluid (CSF) analysis showed proteins of 144 mg/dl, 9000 cells/cmm with 98% of polymorphs. CSF culture did not grow any organism. Echocardiography showed no vegetations. HIV Elisa was negative. MRI brain was suggestive of subdural effusion in left fronto-parietal region with lacunar infarcts noted in cerebrum. There was right internal jugular vein (IJV) thrombosis extending to involve right distal sigmoid sinus and right cavernous sinus. Low molecular weight heparin was started. He became afebrile after 10 days of antibiotics. Repeat blood culture did not grow any organism. Repeat CSF after 21 days of antibiotics was normal. Antibiotics and heparin were stopped after 21 days and patient was discharged. His facial palsy and toe lesions had improved. He was subsequently lost to follow up.

What is the diagnosis and why is there thrombosis of the IJV?


Previous Grand Rounds View All

I
Infantile Hemangioendothelioma - How to treat?
Ira Shah, Amit Dey
A 1 months old boy presented with progressive abdominal distension since 1 month of age and breathlessness for a day. There was no jaundice or pallor. On examination, weight was 3.86 kg. His vital par....
J
Jaundice with triangular facies and pulmonary stenosis
Ira Shah, Aditi Joshi
A 2½ years old girl born of third degree consanguineous marriage presented with progressive abdominal distension for one and a half months along with jaundice at onset. There was no bleeding manifesta....
I
Interstitial Pneumonia and Cytomegalovirus Infection in a 2 month old Child
Ira Shah, Drishti Tolani
A 2 month old girl presented with cough and breathlessness. She was ventilated and detected to have bilateral interstitial pneumonia along with hypoglycemia. Her liver function tests were also abnorma....
L
Lower motor neuron facial palsy in CNS tuberculomas
Ira Shah, Drishti Tolani
An 8 years old boy presented with fever for 19 days with left sided upper limb monoparesis and left lower motor neuron (LMN) facial palsy for 1 day. Cerebrospinal fluid (CSF) showed 25 mg/dl proteins,....
C
Continued Neurological Damage in HIV Infected Despite Antiretroviral Therapy
Ira Shah, Drishti Tolani
A 13 years old HIV infected boy on ART since 6 years of age presented with progressive increase of involuntary movements of left side of body with increased tone in Sept 2011. He was diagnosed to have....
Disclaimer: The information given by www.pediatriconcall.com is provided by medical and paramedical & Health providers voluntarily for display & is meant only for informational purpose. The site does not guarantee the accuracy or authenticity of the information. Use of any information is solely at the user's own risk. The appearance of advertisement or product information in the various section in the website does not constitute an endorsement or approval by Pediatric Oncall of the quality or value of the said product or of claims made by its manufacturer.