A
5-year-old
HIV-infected
boy
with
rash
and
abdominal
pain
(page
3/3)
Prepared
by...
Virat
Sirisanthana,
M.D.
*
|
*
Department
of
Pediatrics,
Chiang
Mai
University
|
> |
He
was
diagnosed
as
having
chickenpox
with
bacterial
pneumonia. |
> |
Acyclovir
(1500
mg/m2/d)
300
mg
q
8
hr
and
cloxaxillin
(100
MKD)
400
mg
q
6
hr
were
administered |
|
|
Progression:
Day
1-2
of
admission
|
Further
management
and
course
in
the
hospital:
|
> |
Despite
parenteral
cloxacillin
and
O2
mask,
his
respiratory
condition
deteriorated.
RR=60/min,
BG
at
O2
mask
6
LPM,
pH
7.48,
PaO2
87,
PaCO2
29,
HCO3
21,
O2sat
=
97%.
|
> |
Body
temperature
was
39.5C |
> |
CXR:
repeated
later
on
day
1
of
admission
(figure
2)
showed
progression
of
the
infiltration
at
rt.middle
and
rt.
lower
lobes |
> |
CXR:
on
day
2
of
admission
(figure
3)
showed
more
progression
of
the
infiltration
at
rt.middle
and
rt.
lower
lobes |
> |
Ceftazidime
was
added
for
fear
of
gram
negative
bacilli
infection.
|
> |
He
was
intubated. |
|
|
Figure
2
Chest
X-ray
later
on
day
1
|
Figure
3
Chest
X-ray
day
2
of
admission
|
|
|
|
Figure
4
Chest
X-ray
day
3
of
admission
|
Figure
5
Chest
X-ray
day
6
of
admission
|
|
|
With
respiratory
support,
he
gradually
recovered
and
was
extubated
on
day
7
of
admission.
He
was
well
at
the
time
of
the
follow
up
a
month
later.
|
|
Further tests for the
etiologic agents showed: |
> |
Intubated suctioned specimen: no
significant organism found (no AFB, no significant
bacteria, no Pneumocystis jirovecii) |
> |
Blood
culture: NG |
|
|
Suggested further
reading: |
|
1. วิรัต
ศิริสันธนะ. Immune Reconstitution Inflammatory
Syndrome ในผู้ป่วยเอชไอวีที่ได้ยาต้านไวรัส. ทวี
โชติพิทยสุนนท์, อังกูร เกิดพาณิช, รังสิมา
โล่ห์เลขา (บรรณาธิการ). Update on Pediatric
Infectious Diseases 2004. กรุงเทพฯ : บริษัท
รุ่งศิลป์การพิมพ์ จำกัด 2547.p 287-93. (review
article in Thai) Full text |
|
2. Hirsch HH, Kaufmann G, Sendi P, Battegay
M. Immune Reconstitution in HIV-Infected
Patients. CID
2004:38:1159-66. (review article)
|
|
|
|
|
|