Pediatric Infection and Vaccine

The Korean Society of Pediatric Infectious Diseases (대한소아감염학회)
권호 표지
DOI QR코드

DOI QR Code

Infectious Pseudoaneurysm Caused by Group A Streptococcus in a Child without Underlying Disease

기저 질환이 없는 소아에서 A군 사슬알균 균혈증에 동반된 감염성 가성동맥류 1예

  • Kim, Kyoung Ha (Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine) ;
  • Lee, Hyunju (Department of Pediatrics, Seoul National University Bundang Hospital, Seoul National University College of Medicine) ;
  • Oh, Chi Eun (Department of Pediatrics, Kosin University Gospel Hospital, Kosin University College of Medicine)
  • 김경하 (고신대학교 의과대학 고신대학교복음병원 소아청소년과) ;
  • 이현주 (서울대학교 의과대학 분당서울대병원 소아청소년과) ;
  • 오지은 (고신대학교 의과대학 고신대학교복음병원 소아청소년과)
  • Received : 2017.06.08
  • Accepted : 2017.08.25
  • Published : 2017.12.25
Download PDF
⟨ Previous Next ⟩

Abstract

Group A streptococcus is a common cause of upper respiratory infection in children; however, it is a rare cause of pseudoaneurysm in pediatrics with only limited reports of cases associated with cardiac surgery and underlying disease. We report a case of infectious pseudoaneurysm of the right internal iliac artery caused by group A streptococcus in a previously healthy 5-year-old boy who presented with scarlet fever and group A streptococcal bacteremia. He was admitted to the hospital with fever, rash on the whole body, and sore throat, accompanied by severe leg pain. He was treated with surgical removal and antibiotics. Because a pseudoaneurysm may develop in children without vascular-related underlying diseases, we should consider the possibility of this important clinical diagnosis in patients with scarlet fever.

A군 사슬알균에 의한 감염성 가성동맥류는 심장 수술 과거력이나 혈관 질환이 있는 환자에서 보고 되어 왔다. 저자들은 이전에 건강하던 5세 남아가 성홍열이 의심되는 상태에서 하지 통증을 호소하여 원인을 찾던 중 A군 사슬알균 균혈증과 함께 오른쪽 내장골동맥의 감염성 가성동맥류를 확인한 사례를 경험하였다. 기저 질환이 없던 성홍열 환자에서도 균혈증뿐만 아니라 가성동맥류와 같은 심각한 침습성 합병증이 생길 수 있으므로 성홍열 환자 진료 시 주의가 필요하다.

Keywords

References

  1. Shulman ST. Group A Streptococcus. In: Kliegman RM, Stanton BM, Geme J, Schor NF, editors. Nelson textbook of pediatrics. 20th ed. Philadelphia: Elsevier Inc., 2016: 1327-37.
  2. World Health Organization. The current evidence for the burden of Group A Streptococcal diseases [Internet]. Geneva: WHO; c2017 [cited 2017 Nov 18]. Available from: http://www.who.int/maternal_child_adolescent/documents/fch_cah_05_07/en/.
  3. Lee HJ. Multicenetric approach for analysis of serotypes of pneumococcus isolated from invasive infections in Korean children (3rd year) [Internet]. Seoul: Korea Centers for Disease Control and Prevention; 2013 [cited 2017 Nov 18]. Available from: http://cdc.go.kr/CDC/cms/cmsFileDownload.jsp? fid=28&cid=61767&fieldName=attach1&index=1.
  4. Korea Centers for Disease Control and Prevention. Infectious diseases surveillance yearbook, 2014 [Internet]. Cheongju: Korea Centers for Disease Control and Prevention; 2015 [cited 2017 Nov 18]. Available from: http://cdc.go.kr/CDC/cms/content/mobile/86/69386_view.html.
  5. Barth H, Moosdorf R, Bauer J, Schranz D, Akinturk H. Mycotic pseudoaneurysm of the aorta in children. Pediatr Cardiol 2000;21:263-6. https://doi.org/10.1007/s002460010054
  6. Biswas JS, Lyons OT, Bell RE, Price N. Extra-aortic mycotic aneurysm due to group A Streptococcus after pharyngitis. J Clin Microbiol 2013;51:2797-9. https://doi.org/10.1128/JCM.00897-13
  7. Bergsland J, Kawaguchi A, Roland JM, Pieroni DR, Subramanian S. Mycotic aortic aneurysms in children. Ann Thorac Surg 1984;37:314-8. https://doi.org/10.1016/S0003-4975(10)60737-0
  8. Restrepo MS, Turek JW, Reinking B, Bergen NV. Mycotic aneurysm in a child with history of coarctation of the aorta repair. Ann Pediatr Cardiol 2014;7:138-41. https://doi.org/10.4103/0974-2069.132493
  9. Sarkar R, Coran AG, Cilley RE, Lindenauer SM, Stanley JC. Arterial aneurysms in children: clinicopathologic classification. J Vasc Surg 1991;13:47-56. https://doi.org/10.1016/0741-5214(91)90011-I
  10. Millar AJ, Gilbert RD, Brown RA, Immelman EJ, Burkimsher DA, Cywes S. Abdominal aortic aneurysms in children. J Pediatr Surg 1996;31:1624-8. https://doi.org/10.1016/S0022-3468(96)90034-2
  11. Chantepie A, Robert M, Pelletier J, Gold F, Mercier C, Lacombe A, et al. Mycotic aneurysm of bronchial artery. Apropos of a case in an infant. Chir Pediatr 1980;21:407-10.
  12. Tachibana K, Takagi N, Kannki K, Higami T. Mycotic aneurysm of ascending aorta in an infant. Asian Cardiovasc Thorac Ann 2013;21:79-81. https://doi.org/10.1177/0218492312444907
  13. Hoffman MA, Ramey AK, Hammel J, Truemper E, Kutty S, Chatterjee A. Recurrent mycotic aneurysm in a 2-yearold boy with group A Streptococcus bacteremia. Pediatr Infect Dis J 2012;31:1080-2.
  14. Kim YW. Infected aneurysm: current management. Ann Vasc Dis 2010;3:7-15. https://doi.org/10.3400/avd.cr09015
  15. Ferretti JJ, Stevens DL, Fischetti VA. Streptococcus pyogenes: basic biology to clinical manifestations [Internet]. Oklahoma City: The University of Oklahoma Health Sciences Center; 2016 [cited 2017 Nov 18]. Available from: https://www.ncbi.nlm.nih.gov/books/NBK333424/pdf/Bookshelf_NBK333424.pdf.
  16. Kaul R, McGeer A, Norrby-Teglund A, Kotb M, Schwartz B, O'Rourke K, et al. Intravenous immunoglobulin therapy for streptococcal toxic shock syndrome: a comparative observational study. The Canadian Streptococcal Study Group. Clin Infect Dis 1999;28:800-7. https://doi.org/10.1086/515199
  17. Carapetis JR, Jacoby P, Carville K, Ang SJ, Curtis N, Andrews R. Effectiveness of clindamycin and intravenous immunoglobulin, and risk of disease in contacts, in invasive group a streptococcal infections. Clin Infect Dis 2014;59:358-65. https://doi.org/10.1093/cid/ciu304
  18. Shah SS, Hall M, Srivastava R, Subramony A, Levin JE. Intravenous immunoglobulin in children with streptococcal toxic shock syndrome. Clin Infect Dis 2009;49: 1369-76. https://doi.org/10.1086/606048
  19. Ogawa T, Terao Y, Sakata H, Okuni H, Ninomiya K, Ikebe K, et al. Epidemiological characterization of Streptococcus pyogenes isolated from patients with multiple onsets of pharyngitis. FEMS Microbiol Lett 2011;318:143-51. https://doi.org/10.1111/j.1574-6968.2011.02252.x
  20. Rasmussen M. Recurrent sepsis caused by Streptococcus pyogenes. J Clin Microbiol 2011;49:1671-3. https://doi.org/10.1128/JCM.02378-10