Case 46

Published on 18/02/2015 by admin

Filed under Allergy and Immunology

Last modified 18/02/2015

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CASE 46

Anne is 20 months of age and has been hospitalized with a fever, irritability, and moderate dehydration. Blood work suggests a bacterial infection, with elevated neutrophils (see Appendix for reference value), although chest radiograph and urinalysis are normal. A lumbar puncture taken yesterday showed an elevated white blood cell count, and preliminary culture results today suggest growth of Neisseria meningitidis. She has been receiving intravenous antibiotics for 30 hours, and there is some improvement in her condition. Physical examination indicated that Anne was below the 50th percentile for weight, had recurrent diarrhea, and had seborrheic dermatitis, more commonly referred to as “cradle cap.” Detailed question of Anne’s clinical history revealed that she had had recurrent infections, but none had ever been this bad. Detailed family history reveals that a distant male cousin and an aunt both died at an early age (<2 years) of meningitis. What further tests might you order? What is the significance of the history and findings?

QUESTIONS FOR GROUP DISCUSSION

2. Because preliminary culture results suggested growth of Neisseria meningitidis, Anne was diagnosed with systemic inflammatory response syndrome (SIRS), formerly referred to simply as “sepsis” during infection. Review the processes that are activated during inflammation (see Case 23), with emphasis on the role of interleukin (IL)-1 and tumor necrosis factor (TNF). Note that the current dogma states that SIRS leads to the excessive release of cytokines that produce fever, shock, and often death.

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