Síndrome torácica aguda em paciente escolar com doença falciforme: um relato de caso

Abstract

OBJECTIVE: To describe the case of a male pediatric patient with acute thoracic syndrome (ATS) in sickle cell anemia, linking it to the medical literature. CASE DESCRIPTION: A 9-year-old male patient, developed strong pain associated to headache and priapism, hence admitted to the emergency of a tertiary referral hospital. A priapism relief was noticed after hydration and morphine sedation. He developed severe acute thoracic syndrome, pneumonia and pleural effusion. The use of cefotaxime, clindamycin and clarithromycin was started. Mechanical ventilation was necessary and the patient was sent to the intensive care unit. On the tenth day, patient developed sepsis consequently cefotaxime and clindamycin were interrupted and piperacilin + tazobactam + linezoline were introduced. Kept clarithromycin. On the twelfth day, he had prophylaxis for pulmonary thromboembolism (TEP) with enoxaparin due to the expanded D-dimer. A second TEP was confirmed after some days. Three blood transfusions were needed during the hospitalization. He recovered gradually and was discharged on the thirty-sixth day keeping on thromboembolism prophylaxis until his return for other tests. COMMENTS: Patient had the infection and pulmonary thromboembolism as possible causes to trigger the acute thoracic syndrome. As observed in the medical literature, the pain crises anticipated the ATS. Alterations were observed on the laboratorial tests and imaging exams compatible with cases described by other authors. The good progress was the reflex from the adequate diagnosis and treatment.