Fatal pulmonary hemorrhage associated with micrococcal infection in two children with acute lymphoblastic leukemia

Kytococcus schroeteri pneumonia in two patients with a hematological malignancy

Neutropenic patients are susceptible to infections with usually harmless microorganisms. We report two cases of severe pneumonia in hematological patients due to Kytococcus schroeteri, a saprophyte of the human skin. When blood cultures or respiratory specimens yield micrococcus-like colonies, Kytococcus species, which are often resistant to penicillin, should be considered and the antimicrobial therapy should be adjusted accordingly.

Successful use of surfactant to treat severe intrapulmonary hemorrhage after iatrogenic lung injury--A case report

OBJECTIVE

To describe the beneficial clinical effect of the use of surfactant in a patient with severe unilateral pulmonary hemorrhage after iatrogenic lung injury during corrective surgery for congenital heart defects.

DESIGN

Case report.

SETTING

Pediatric cardiac intensive care unit of a tertiary care hospital.

PATIENT

An 11-wk-old boy.

INTERVENTIONS

Intratracheal instillation of 4 mL (100 mg) of surfactant (Survanta) per kilogram of body weight to treat profound and refractory hypoxia and hypercapnia despite high-ventilation pressures, high respiratory rate, and the use of nitric oxide caused by severe pulmonary hemorrhage and atelectasis.

MEASUREMENTS AND MAIN RESULTS

The aggressive ventilation variables could be reduced within the following 2 hrs after surfactant use (from Fio2 0.8, peak inspiratory pressure 36 cm, positive end-expiratory pressure 10 cm, respiratory rate 50, tidal volume 63 mL, and nitric oxide 10 ppm to Fio2 0.4, peak inspiratory pressure 28 cm, positive end-expiratory pressure 10, respiratory rate 40, tidal volume 38 mL, and nitric oxide 5 ppm). There was rapid improvement of clinical variables (inotropic support, chest radiograph) as well as oxygenation (Pao2 from 56 to 149 mm Hg), CO2 exchange (Paco2 from 85 to 39 mm Hg), and acidosis (from pH 7.13 to 7.44).

CONCLUSIONS

The administration of surfactant may be a promising approach to treat severe respiratory failure caused by severe pulmonary hemorrhage.