[Different clinical forms of adrenal abscess in two newborns]

Adrenal abscess is a rare disease in the neonatal period. The classical symptoms are abdominal mass, anaemia and prolonged jaundice which are associated with fever, vomiting and feeding difficulties. The authors present the histories of two mature, male newborns with adrenal hemorrhage, where the size of the masses increased progressively and finally adrenal abscesses were developed. The first case showed the classical symptoms of adrenal abscess, however, the antibiotic treatment led to complete remission of the symptoms and laboratory infectious markers, therefore the baby was discharged. In a few day later he became septic and was admitted again. This time he was operated on and a large abscess was evacuated, which contained about 60 ml of pus. After this intervention multi-organ failure developed, but due to the intensive therapy the baby recovered. In the second newborn the increasing adrenal hemorrhage was accompanied by elevated infectious markers despite of the different antibiotic treatments, however, he showed no clinical signs of infection. Because of the discrepancies between the clinical and laboratory findings and also the imaging studies the possibility of neuroblastoma has also arisen. Urinary vanillylmandelic acid excretion was normal, but elevated neuron-specific enolase levels were measured. Surgical exploration was performed, pus was drained from the mass and anaerobic Bacteroides fragilis was cultured, therefore metronidazole therapy was started. After that the baby fully recovered.