9 Disseminative thromboembolic affect of intracranial, pulmonary, upper, and lower extremities small vessels caused by catheter-related sepsis in infant

Abstract Female infant (date of birth 03.10.2021) was treated in an infectious disease hospital with adenovirus infection. Due to deterioration of clinical condition, she was transferred to our hospital. At the time of admission, complained of difficult breathing, febrile temperature (up to 39°C), and generalized rash on the skin. It was painful hyperemia on the right forearm at the site where intravenous catheter was placed. On the background of fever, the child developed the cramps. Due to that, she was hospitalized to the intensive care unit. The bilateral pleuropneumonia with partial atelectasis of lower poles of both lungs, which required the mechanical ventilation, was revealed on plain chest radiography. Laboratory tests revealed the elevated WBC (17.8 × 109/l), decreased platelets count (121 × 109/l), coagulative disorders—increased fibrinogen level (9.92 g/l), prothrombin time (27.5 s), INR (2.33), D-dimer (1.48 mg/l), and decreased prothrombin index (44.4%); procalcitonin level was normal (0.25 mg/ml). St.aureus was isolated from blood that susceptible to meropenem, clindamycin, and tigecycline. Glasgow coma score—8 points; possible to thromboembolic affect of intracranial vessels. Antibacterial treatment started with intravenous clindamycin (300 mg/day), meropenem (20 mg/kg in 3 doses/day). Child also received heparin (100 mg/kg in 4 doses/day), pentoxifylline (50 mg in 2 doses/day), and intravenous infusions. Despite the treatment, appeared and intensively increased the edema of the left upper extremity and both shins and feet; skin became cyanotic and cold. Diagnosed the critical ischemia of left upper extremity and both lower extremities, due to that the fasciotomy was performed. The intensive therapy was continued with the gradually improving of the clinical condition: complete recovery of consciousness, restore of spontaneous breathing, normalizing laboratory test, and body temperature. Besides that, the dry gangrene of all fingers of the right foot and second finger of the right arm, and necrotic changes of the skin on dorsal and plantar surface of the right foot was developed. Necrosis was removed by staged necrosectomy with VAC-system applying and wounds gradually healing by the secondary tension. Child was discharged after 52 days in good condition. This case illustrated severe catheter-related sepsis complicated by disseminative thromboembolic affects of the small vessels in different regions.