Complicated pneumococcal pneumonia in children at a university hospital in São Paulo (Brazil)

Physical examination, laboratory studies, radiographic data (including chest CT scan), abdominal ultrasound, diagnostic thoracentesis established the diagnostic: 1. S. pneumoniae: Pneumonia of the RUL and RLL, complicated with pleural empyema. 2. D-Hemolytic Uremic Syndrome (HUS) (mediated by neuraminidases) 3. Hypocomplement C3, C4. Differential diagnostic was difficult: sepsis with pleural pulmonary and renal determination, parenchymal malformations were discussed. The treatment included: fluid therapy with monitor electrolyte and hydration status, platelets transfusion, packed RBC, IV immunoglobulines, albumin replacement, plasma infusion, diuretics and IV antibiotics (doses adjusted for glomerular clearance) for 7 weeks: meropenem, ertapenem, zyvoxid, ciprofloxacin, clindamycin. She didn’t need dialysis, or mechanical ventilation. Pulmonary outcome was good, with total recovery; after 3 months chest CT was normal. Renal outcome was good, with no recurrence. We discuss the severity of lung damage with a lot of pneumatoceles, but without pneumothorax or chronic empyema – that progressively resolved with antibiotic therapy in a child of 2 years that was vaccinated. It is the first case in our experience that associates HUS. We couldn’t explain this evolution on a genetic deficiency of the immune system (normal IgG, IgM, IgA, normal MBL), except complement C3, C4 decreased during the acute episode. We couldn’t determine the pneumococcal serotype, but it is possible to be 19A, the most frequent serotype that determine empyema or SHU, according to the studies from North America and Australia, serotype that is not present in 10 valent vaccine.