Ibuprofen
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Fournier’s gangrene in an infant: case report A 6-month-old boy developed Fournier’s gangrene during treatment with ibuprofen; he subsequently died from multiple organ failure. The boy started receiving ibuprofen [route and dosage not stated] and amoxicillin for acute otitis media. After 5 days’ treatment, he presented with dysenteric, diarrhoealike stools and was found to have dermatitis in the perineal area. Less than 24 later, his lesion spread to the genital area. He developed oedema, signs of ischaemia, fever, respiratory distress and a deterioration in his general condition. On arrival to hospital, he had a marked respiratory effort, tachycardia, arterial hypotension and was septic. He had necrosis in his perineal area and testicular oedema. He was diagnosed with Fournier’s gangrene, septic shock and respiratory failure. The boy was placed on a ventilator and received vasopressor support and was transferred to the ICU. He started receiving piperacillin/tazobactam, vancomycin and clindamycin. Laboratory tests revealed leucopenia, anaemia, thrombopenia and disseminated intravascular coagulation, and he was given multiple transfusions with erythrocytes, platelets and fresh frozen plasma. He underwent surgical debridement and a colostomy. A further three debridement procedures were required to control the necrosis. Pseudomonas aeruginosa was isolated in two blood cultures and his antibiotics were changed to meropenem and amikacin. On day 10 of admission, he had marked abdominal distension and deterioration in his general condition; three ileal perforations were found and repaired. On day 14, he experienced grave haemodynamic deterioration and respiratory distress. He was diagnosed with pneumonia and acute respiratory distress syndrome, and received further antibiotic treatment. However, he subsequently died from multiple organ failure. Author comment: Although further evidence is still necessary, the association that was found between the intake of an NSAID, [necrotising fasciitis] and [Fournier’s gangrene] suggests that we should be very cautious when prescribing these drugs to children. Garces C, et al. An unusual presentation of Fournier’s gangrene. Is there a relationship with NSAID use? Pediatric case report. Revista Chilena de 803050601 Infectologia 27: 341-4, No. 4, Aug 2010 - Colombia
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Reactions 12 Mar 2011 No. 1342
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