We report a case of neonatal staphylococcal sepsis presented with retropharyngeal abscesses, mediastinitis, infection of chest wall soft tissue, myopathy, cardiorespiratory failure, acute dilatation of the left coronary artery and echocardiographic signs of Kawasaki syndrome.
A female newborn hospitalised at 18th day of age due to SOB, groaning, cyanosis and a limp body – the third child from a second regular pregnancy, term delivery, vaginal birth, birth body weight of 3780 g, Apgar score 9/10. She was discharged as healthy at the 5th day of age after treatment with phototherapy for hyperbilirubinemia over 66 hours period with concomitant asymptomatic S. aureus nasopharyngeal colonization. Parents are healthy and have healthy two-year old twins, negating hereditary diseases. At home, on a natural diet, the parents noticed flabbiness of the newborn. Other symptoms appeared suddenly upon admission.
Staphylococcus epidermidis is common cause of neonatal sepsis in our hospital. This is the first time we dealt with the above localization and complications. Although literature describes cases of neonatal Kawasaki syndrome, we were suspicious this was the case with our patient because she was in sepsis, and in addition to dilatation of left coronary artery, endocarditis vegetations were observed. Also observed expansion increased after immunoglobulin treatment. Serology for Epstein-Barr, Coxsackie and Parvovirus (IgM and IgG) was positive, and there was early complication of staphylococcal sepsis by candidiasis. Due to pressure on the trachea and pneumonia with pneumatocela, respiratory failure followed and three-weeks of mechanical ventilation ensued. Severe upper extremities myopathy developed due to retropharyngeal abscess compression on the cervical spinal medulla at the C1 and C2 level. With antistaphylococcal treatment and several retropharyngeal abscess evacuations, patient was extubated after three weeks. Given that myopathy remained after six weeks of therapy, higher institution (IZZMD-Beograd) was consulted. It was determined that the compression of the spinal cord was due to spinal canal stenosis as a result of destruction and dislocation of atlantoaxial vertebrae (Grisel’s syndrome), caused by osteomyelitis. Compression resulted in quadriparesis and neurogenic bladder. Eight-week antibiotic treatment was initiated that successfully handled the infection. Due to atlantoaxial subluxation initially a Tomas collar was used to stabilise the spine and surgical treatment at the Clinic of Neurosurgery in Warsaw followed. The patient’s neurological status remained unchanged and was discharged. She was again hospitalised 28 days after surgery because of severe respiratory insufficiency. The patient remains on mechanical ventilation and still suffers from severe myopathy.
This work is licensed under a Creative Commons Attribution 4.0 International License