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2020, Number 3

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Acta Pediatr Mex 2020; 41 (3)

Cardiac thrombosis associated with systemic mycosis in the newborn. Case report and review of the literature

Carrillo-Arteaga HS, Corona-Cordero AL

Language: Spanish
References: 18
Page: 128-134
PDF size: 395.57 Kb.


ABSTRACT

Background: Intracardiac thrombosis associated with systemic mycosis is a rare condition in the newborn, although with high morbidity and mortality. It can be secondary to procedures such as the installation of a central catheter that is contaminated by fungi. The intracardiac thrombus should be treated with fibrinolytics as the tissue recombinant plasminogen activator (rTPA). This drug is highly effective in dissolving the thrombus and its effectiveness should be monitored by echocardiography.
Clinical case: Premature of 30 weeks gestation, with respiratory distress after birth, so it required supplemental oxygen. At 14 days of life, it was decided to install a central catheter by venodisection and 21 days later it shows signs of systemic inflammatory response accompanied by pulmonary and digestive bleeding. Receive multiple antimicrobial schemes and at 35 days of age, Candida Parapsilosis is identified in central and peripheral blood cultures that adequately responds to treatment with voriconazole for 28 days. At 53 days of age presented persistent hypotension and tachyarrhythmias and the echocardiogram reports giant thrombus in the right atrium that protrudes to duranthe right ventricle through the tricuspid valve. Receive rTPA management for a period of 12 hours, which results in reduction of the size of the intracardiac thrombus until practically disappearing before discharge
Conclusions: Intracardiac fungal thrombosis requires the early installation of antifungal treatment and proper management of the thrombus through the use of fibrinolytics such as rTPA, in order to avoid life-threatening complications in the premature newborn.


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