Search

Acute respiratory distress syndrome (ARDS) is a life-threatening condition despite medical development. Unlike adult, ARDS, in pediatric population, has been recently defined in the Pediatric Acute Lung Injury Consensus Conference (PALICC), 2015. We conduct a retrospective descriptive study, in pediatric intensive care unit (PICU) of Hassan II University Hospital during a period of 2 years (2019 to 2021) in which we included 23 pediatric cases of ARDS defined using 2012 Berlin criteria. They represent 2.7% of all patients admitted in our unit (23 patients of 850 admissions), with a male predominance 17 males/6 females, the median of age was 4.6 years-old (2 months to 14 years-old). Pediatric acute respiratory distress syndrome (PARDS) cases were stratified as mild in 13% (n=3), moderate in 52% (n=12), and severe in 35% (n=8). The etiologies were of pulmonary origin (pneumonia, aspiration, pulmonary contusion, and foreign body) in 79% of cases (n=18), and extra-pulmonary origin (sepsis, burn and major trauma) in 21% (n=5). The management was based on lung protective invasive mechanical ventilation (95%, n=22), Prone positioning was applied (26%, n=6), inhaled nitric oxide (iNO) was used in (35%, n=8), recruitment maneuvers (56%, n=13), neuromuscular blockade (NMB) (74%, n=17) and extracorporeal membrane oxygenation (ECMO) in 1 case. The outcome was favorable in 65% (n=15) with a mean PICU-stay of 20 days (SD=16 days). Overall mortality rate was 35% (n=8), and 100% (n=5) in case of extrapulmonary (indirect) etiologies. It was proportional to the disease severity, 50% (4 of 8 cases), 33% (4 of 12 cases), and no death respectively in severe, moderate, and mild PARDS. PARDS in our context is a serious problem as it is more frequent in children < 5 years, a population considered as fragile, with a high mortality rate especially in indirect lung etiologies of PARDS., Competing Interests: The authors declare no competing interests., (Copyright: Said Benlamkaddem et al.)

Eisenmenger syndrome (ES) is the end stage of pulmonary arterial hypertension (PAH) associated with congenital heart disease (CHD), which can occur in patients with large, unrepaired cardiac shunts (ventricular septal defects (VSD), atrial septal defects (ASD), and patent ductus arteriosus (PDA)). Pregnancy in Eisenmenger syndrome is uncommon and is poorly tolerated due to physiological changes that may lead to a risk of rapidly progressive cardiopulmonary decompensation, thrombotic complications, and sudden death. For these reasons, it is advisable, in this context, to avoid pregnancy or to undergo an early pregnancy termination within the tenth gestational week. The occurrence of severe preeclampsia in this situation leads to fatal maternal and fetal outcomes. We report the case of a 23-year-old female patient, gravida 1 nullipara at the thirty-fourth week of gestation, with a history of a persistent ductus arteriosus (PDA) in childhood that progressed to ES. She was admitted to the obstetric emergency for respiratory distress associated with signs of low cardiac output. CT pulmonary angiography and transthoracic echocardiography showed no pulmonary embolism, an enlarged pulmonary artery, dilated right cardiac chambers (ventricle and atrium) compressing the left ones, a right ventricular/left ventricular (RV/LV) ratio > 1, a persistent ductus arteriosus, and a calculated systolic pulmonary arterial pressure (PAPS) at 130 mmHg. She also had severe preeclampsia with evolutive HELLP (hemolysis, elevated liver enzymes, low platelet count) syndrome and intrauterine fetal death indicating fetal delivery under general anesthesia after platelets transfusion. At the end of the surgery, the patient presented a sudden death following a cardiac arrest despite 45 minutes of cardiopulmonary resuscitation., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Benlamkaddem et al.)

Rhino-orbital cerebral mucormycosis is a rare and serious fungal infection caused by fungi of the Mucorales order, most commonly by the species Rhizopus oryzae . It occurs generally in an immunocompromised host, and the contamination of healthy subjects remains exceptional. The clinical presentation is not specific. The diagnosis of rhino-orbital cerebral mucormycosis is difficult based on a range of clinical, microbiological, and radiological arguments. Imaging studies may include CT/MRI of the orbit, brain, and sinuses and show signs of aggressiveness, intracranial complications, and evolution under treatment. The standard treatment is antifungal therapy and necrosectomy. We report a case of a 30-year-old patient admitted to intensive care for the management of postpartum hemorrhage complicating severe preeclampsia who presented with rhinocerebral mucormycosis with left orbital extension. Adequate therapeutic management in the intensive care unit was provided; however, the patient died within seven days of septic shock with multiorgan failure. The mortality is determined by the correction of risk factors, the timing of initiation of the antifungal therapy, and surgical debridement., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Benlamkaddem et al.)

Macrophage activation syndrome (MAS) is a rare but potentially fatal disease. It is characterized by hyperinflammation, including the proliferation and activation of immune cells (CD8 T cells and NK cells) associated with hypercytokinemia. Patients present with fever, splenomegaly, and cytopenia, associated with a hemophagocytosis picture in the bone marrow. It can progress to a multiorgan failure syndrome (MODS), mimicking sepsis or a systemic inflammatory response syndrome (SIRS). We report the case of an 8-year-old girl admitted to the pediatric intensive care unit for the management of major trauma due to a domestic accident. She presented with a protracted fever in the context of a septic shock, despite appropriate treatment. The association with bicytopenia, hyperferritinemia, hypofibrinogenemia, and hypertriglyceridemia was suggestive of MAS which was confirmed by a bone marrow puncture showing hemophagocytosis. A Bolus of corticotherapy was then added to the supportive treatment and broad-spectrum antibiotherapy, with a good outcome., Competing Interests: The authors have declared that no competing interests exist., (Copyright © 2023, Benlamkaddem et al.)

Hepatic infarction is a rare and fatal complication associated with hemolysis, elevated liver enzymes and low platelets syndrome. It can develop into fulminant liver failure and lead to death in 16% of cases. A 25-year-old woman, with unremarkable prenatal history, was sent to gynecological emergency unit for management of severe preeclampsia at 30 weeks and 4 days of pregnancy. Initial laboratory studies revealed aspartate aminotransferase at 290 U/L, alanine aminotransferase at 193 U/L and a normal value of hemoglobin, platelets and the prothrombin time. Behind the persistence of high blood pressure despite dual therapy, an emergent cesarean section was performed. However, two days after surgery, the patient accused an epigastric pain and was subsequently noted to have developed HELLP syndrome: thrombocytopenia (77000 /ul), anemia (hemoglobin 9.1 g/dL) and worsened liver injury (aspartate aminotransferase 2809 U/L; alanine aminotransferase 2502 U/L). A thoraco-abdominopelvic computed tomography (CT) was performed, which revealed massive hepatic infarction more marked on the right lobe, by showing the existence of diffuse hypodense plaques, poorly limited, not enhanced after injection, interesting all hepatic segments. The vascular permeability of the portal and subhepatic was preserved. During the surveillance, the laboratory tests worsened (hemoglobin = 4,6 g/dl; platelets count = 20000 /ul; WBC = 26000 /ul; CRP = 340 mg/l; albumin = 16 g/l, prothrombin time (PT) = 50%). The patient received antibiotics, she was transfused by red blood cells and platelets concentrates, she also received albumin with the pleural effusion drainage. The damaged hepatic areas stayed stable in control CT and the patient gradually improved here biological test, to become normal at 11 days after delivery. Hepatic infarction is an extraordinarily rare complication of preeclampsia. The diagnosis should be suspected by noting elevated liver enzymes, thrombocytopenia and typical images of hepatic infarction on abdominal CT. Early recognition and multidisciplinary management is necessary to prevent hepatic failure and death., Competing Interests: The authors declare no competing interests., (© Linda El Allani et al.)

Perthes syndrome is defined by the association among subconjunctival hemorrhage, cervicofacial cyanosis and petechiae up to neurological manifestations. Violent compression of the thorax or thoracoabdominal block after forced inspiration with glottis closure due to effort is the mechanism responsible for the syndrome. Prognosis is generally good if the compression is brief and cardiopulmonary resuscitation has been started early. The purpose of this study was to describe the features of Perthes syndrome among children., Competing Interests: Les auteurs ne déclarent aucun conflit d’intérêts., (© Soufiane El Youssfi et al.)

Triclopyr is a pyridine derivative, widely used as an herbicide. It controls plant growth by interfering with plant growth hormones, auxins. It should have few effects in humans as these are nonexistent in mammals. It can prove however very severe in cases of acute poisoning.

Isoniazid is an antimycobacterial agent commonly prescribed in most tuberculosis chemotherapy regimens. Its side effects are widely known including mainly liver toxicity and peripheral neuropathy. The toxic effects of isoniazid are dose-related. Toxic doses are estimated at 35-40 mg/kg and fatal doses at 150 mg/kg. Treatment consists primarily of basic life support, antiepileptic drugs, and pyridoxine. The case is of one of the children with intentional isoniazid poisoning, the drug belonging to an uncle currently under antituberculosis treatment, resulting in tonic-clonic seizures. During her hospitalization in the paediatric intensive care unit, her neurological status as well as her lab values was closely monitored, and despite initial deterioration, the patient was discharged from critical care a week after full recovery.

Spontaneous pneumomediastinum is defined as free air or gas contained within the mediastinum, which almost invariably originates from the alveolar space or the conducting airways. It is rare in pediatric patients; however, occasional cases are reported to result from forced Valsalva's maneuver due to cough, emesis, a first attack of wheeze, or asthma exacerbations. We report the case of a 7-year-old previously healthy girl, with a history of persistent dry cough one day before, who was brought to our unit with face, neck and chest swelling. The chest X-ray and computed tomography (CT) scan showed subcutaneous emphysema with pneumomediastinum and pneumopericardium without evidence of the origin of this air leak. Laboratory tests and the bronchoscopy were normal. The patient was admitted in the pediatric critical care and received noninvasive monitoring, analgesia, oxygen, and omeprazole as a prophylaxis for a gastric ulcer. The patient improved, subcutaneous emphysema resolved, and she was discharged on the third day., Competing Interests: The authors declare no conflict of interest.

Spontaneous pneumomediastinum and subcutaneous emphysema also known as Hamman's syndrome is a very rare complication of labor that is often related to the valsalva maneuver during the labor. In most case, Hamman's syndrome is a self-limiting condition, rarely complicated unless there are underlying respiratory diseases. Chest X-ray can be a useful early diagnostic technique in severe clinical presentation. We report an uneventful pregnancy in a primigravid parturient, which was complicated in the late second stage of labor by the development of subcutaneous emphysema, pneumomediastinum, and mild pneumothorax. Spontaneous recovery occurred after four days of conservative management. This condition shows the major interest of labor analgesia especially locoregional techniques., Competing Interests: The authors declare no conflict of interests.