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[Severe upper airway obstruction in infectious mononucleosis: a life emergency]
B Salazard1, O Paut, R Nicollas
1Département d'anesthésie-réanimation pédiatrique, centre hospitalier universitaire Timone, boulevard Jean-Moulin, 13385 Marseille, France.
Insights
Severe airway obstruction in infectious mononucleosis (IM) can be life-threatening. Early tonsillectomy and searching for herpes virus infection are key to managing this rare complication in children.
Area of Science:
- Pediatric Otolaryngology
- Pediatric Infectious Diseases
- Pediatric Critical Care Medicine
Background:
- Infectious mononucleosis (IM) can lead to severe, life-threatening upper airway obstruction.
- Prompt recognition and management are crucial for pediatric patients experiencing airway compromise due to IM.
Observation:
- A 9-year-old girl presented with obstructive dyspnea during IM, unresponsive to corticosteroids and intubation.
- Persistent pharyngo-tonsillar swelling indicated a severe obstruction.
- Histological examination revealed a concomitant herpes virus infection.
Findings:
- Surgical adenotonsillectomy provided immediate relief, enabling tracheal extubation and rapid recovery.
- Concomitant herpes virus infection can exacerbate airway obstruction in IM.
- Early tonsilloadenoidectomy is an effective intervention for severe IM-induced airway obstruction.
Implications:
- Instrumental interventions, including surgery, may be necessary for maintaining airway patency in severe IM cases.
- Screening for herpes virus in children with IM and airway obstruction is recommended for tailored treatment.
- This case highlights the importance of considering surgical options for refractory airway obstruction in pediatric IM.
Background:
Upper airway obstruction can represent a severe, life-threatening complication of infectious mononucleosis. We report a rare case of airway obstruction in a child with infectious mononucleosis associated with herpes virus infection, and we discuss management strategy that can be proposed in such cases.
Case Report:
A 9-year-old girl was hospitalised in intensive care unit for obstructive dyspnea during infectious mononucleosis. Despite five days of corticosteroids and tracheal intubation, persistent pharyngo-tonsillar tumefaction led us to perform a surgical adenotonsillectomy. This latter treatment allowed immediate tracheal extubation and a rapid recovery. Histology showed a herpes virus infection associated with infectious mononucleosis.
Conclusion:
Maintaining airway opening in infectious mononucleosis needs sometimes to use instrumental interventions: nasal trumpet, endotracheal intubation, even tracheostomy. Early tonsilloadenoidectomy may relieve airway obstruction and allow a rapid recovery in the most severe cases. Airway obstruction in infectious mononucleosis may be aggravated by concomitant herpes virus infection that should be searched for in this situation, in order to adapt the treatment.