2011, Number 1
Pneumonia and pericardial effusion in pediatric patients with Down syndrome and hypothyroidism: report of 4 cases tended to in the emergency department
Avilés-Martínez KI, Pintor-Márquez GT, Meza-Jáuregui AL, Magaña-Cárdenas MT, Jasso-Estiven J, Mesino-Armenta T, López-Enríquez A
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ABSTRACT
Background: There are no case reports in literature in which it is observable a relation among Down syndrome, Hypothyroidism, pneumonia, pericarditis and pericardial effusion that compromises in a grave way the patient's life.Objective: Presentation of 4 clinic cases of patients with Down syndrome admitted in pediatrics emergency department for showing respiratory failure secondary to pneumonia, in whom pericarditis and pericardial effusion were found associated to hypothyroidism, with evolution towards respiratory distress syndrome and hemodynamic failure.
Methods: Were included, 4 patients with Down syndrome admitted to pediatrics emergency in the Fray Antonio Alcalde Civil Hospital for respiratory failure, cardiomegaly and hemodynamic instability. The patients were initially evaluated and categorized in accord to the guidelines of the American Academy of Pediatrics, posteriorly diagnosed with hypothyroidism and pericardial effusion.
Results: The universe of study included 4 (100%) patients with Down syndrome, 50% (n=2) female and 50% (n=2) male, aged on average 15 months ± 12 being minimum 6 months and 30 months the maximum. 100% (n=4) of the cases showed arterial hypotension when admitted. 25% of the patients (n=1) was diagnosed with hypothyroidism at admission, but with no pharmacological control of the disease, the 75% (n=3) was diagnosed with hypothyroidism 48 hours after their admission. In 100% of the cases (n=4) was established the clinical and radiological diagnosis of pneumonia, but in none of the cases was possible to identify the etiological agent. An echosonogram was done to 100% of the patients (n=4) and all of them were diagnosed with pericarditis and pericardial effusion. 75% of the patients (n=3) died of multiple organ failure second to hard to control cardiogenic shock.
Conclusions: Medics working at the pediatrics emergency department must be aware and apply the guidelines of the American Academy of Pediatrics published in 2001 for the follow-up and control of a patient with Down syndrome. Every patient with trisomy 21 screening respiratory failure and shock state should be evaluated in order to know their thyroidal function, in spite of having a previous diagnosis of hypothyroidism. It is also important to do an echo-cardiographic evaluation to discard the presence of a pericardial effusion or pericarditis, which would complicate even more the patient status.
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