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Extreme hyperpyrexia in childhood. Presentation similar to hemorrhagic shock and encephalopathy
Insights
Five young children experienced critical hyperpyrexia (high fever), with four fatalities. This severe illness, resembling hemorrhagic shock and encephalopathy syndrome (HSES), was not caused by bacterial sepsis.
Area of Science:
- Pediatric critical care medicine
- Infectious disease diagnostics
- Neurology
Background:
- Previously well children presenting with extreme hyperpyrexia are rare.
- Distinguishing severe febrile illnesses in infants is crucial for timely intervention.
Observation:
- Five pediatric cases over 14 years showed admission temperatures >42.0°C (107.6°F).
- All patients exhibited a similar clinical presentation with hyperpyrexia as a key feature.
- Four out of five children died, indicating a severe and often fatal outcome.
Findings:
- Bacterial sepsis was excluded through negative blood, cerebrospinal fluid, and stool cultures.
- The clinical syndrome closely resembles hemorrhagic shock and encephalopathy syndrome (HSES).
Implications:
- This case series highlights a severe, potentially fatal hyperpyrexic illness in young children.
- Early recognition and differentiation from bacterial infections are critical for managing this condition.
- Further research into the etiology and treatment of this HSES-like syndrome is warranted.
Abstract:
The authors report the cases of five previously well children, aged 8 to 33 months, who were seen over a 14-year period, with admission temperatures in excess of 42.0 degrees C (107.6 degrees F). Four of the patients died. Each child had a similar clinical illness in which the hyperpyrexia played a critical role. Negative blood, cerebrospinal fluid, and stool cultures excluded bacterial sepsis as a possible etiology. This illness is similar, if not identical, to the newly described syndrome of hemorrhagic shock and encephalopathy (HSES) reported in European and American infants.