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PP-066 Necrotizing pneumonia in a child with covid-19
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  1. Ergena Neziri,
  2. Laureta Sadedini,
  3. Floreta Korumi,
  4. Irma Hajdari,
  5. Albert Lama,
  6. Perparim Shira
  1. Mother Teresa University Hospital Center

Abstract

Aim A 10 year old boy was brought with complains of fever, cough, shortness of breath, generalized weakness since one week. His parents refered that he was previously healthy No allergic history nor contact with TB patient. He was fully immunized but it was COVID-19 high endemic time ( july 21) and his closed friend was COVID-19+. He was hospitalized. Laboratory tests showed Hb 11.9 HCT 36.5, PCR 29, WBC 19x 10³, PLT 699 x 10, PCR COVID-19 positive. Diagnosis of Covid-19+ Pneumonia was done and it was started Ceftriaxone 1gr/12hIV, Remdesivir 200 mg/24 h Day 1° followed by 1x100 mg/24h for 4 day. Despite the start of treatment the child had Increased dyspnea, desaturation, high grade fever. Chest X ray revealed bilateral pneumonia (figure 1). Blood Culture: Staphylococcus aureus Sensitive: Gentamicin, levofloxacin. Antibiotic were switched to: Levofloxacin + Gentamicin. As his clinical condition were not good he was transfered at our University Hospital center. On our hospital admission chest X ray revealed Bilateral Pneumonia and Bilateral pleural effusion dominant on the right side GCS 456 BP105/68 mmHgHR 136 bpm regular, RR 45 pm axillary temperature 38.8°C, SpO2 94–96%. Not anemic, not cyanotic, dyspnea, no lymph node enlargement, no dysmorphism on the face, nasal flaring. Asymmetrical chest movement, suprasternal retraction, Lung sound: crackles+wheeze- right lung dullness to percussion. Chest CT-Scan No bronchopleural fistula, bilateral effusion, right fluidopneumothorax, bilateral consolidation with multiple cavitary lesions on both lungs, indicating necrotizing pneumonia. Pleural fluid culture: MRSA. It was started PRC transfusion, albumin 20% correction, electrolyte correction, vancomycin IV. On day 15 he has dry cough and fever HB 10.5 HCT 32% WBC 17.9 X 10³ D-Dimer16010, Fibrinogen 504.8, Blood Culture Sterile. On day 19 D-dimer 6850 INR 1.08 Fibrinogen 608 WBC 8.8 x 10³Hb 10.8 HCT30.5ALB 3.5. Vancomycin was stopped on day and it was started Ribaroxavan 1x 20 mg PO

Material and Method Case report.

Results Case report.

Abstract PP-066 Figure 1

Chest CT scan.

Conclusions Necrotizing pneumonia is a severe form of CAP characterized by rapid progression of consolidation to necrosis and cavitation which may lead to pulmonary gangrene

  • necrotizing pneumonia
  • pleural effusion
  • MRSA
  • staphylococcus aureus
  • vancomicyn

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