Document Type : Case Report

Authors

1 Pediatrician, Department of pediatrics, Clinical Research Development Center of Children’s Hospital, Hormozgan University of Medical Sciences, Bandar Abbas, Iran

2 Clinical Research Development Center of Children Hospital, Hormozgan University of Medical Science. Bandar Abbas, Iran

10.22038/ijn.2024.78617.2528

Abstract

Introduction: Lumbosacral abscesses in neonates are an uncommon yet sig-nificant medical condition, often linked with congenital anomalies or immu-nodeficiency disorders. The complexity of these infections is exacerbated when they involve multiple abscesses and/or coexist with simultaneous mi-crobial and fungal infections. This report presents a unique case of a neo-nate who developed multiple lumbosacral abscesses due to mixed bacterial and fungal infections, a scenario not previously documented in the litera-ture.

Case Presentation: An 8-day-old male neonate was delivered via normal vaginal delivery at 36 weeks and 5 days without reported maternal compli-cations. Initial symptoms included irritation and cutaneous lesions in the genital and lumbosacral areas, which progressively worsened despite topical treatments and antibiotics administered at initial healthcare visits. Upon hospitalization, the patient exhibited multiple lumbosacral abscesses, rang-ing from 1.5 to 8 cm, alongside systemic signs such as mild fever and irrita-bility. Laboratory analysis revealed elevated inflammatory markers (eryth-rocyte sedimentation rate=21 mm and C-reactive protein=27 mg/dL) and positive KoH smears indicating potential fungal presence. Pathogen identifi-cation through culture showed Staphylococcus aureus, Klebsiella, and E. coli, alongside fungal infection. Imaging studies ruled out spinal canal in-volvement, and a comprehensive treatment involving antifungal therapy (fluconazole) and broad-spectrum antibiotics (Cefotaxime and Vancomycin) was initiated. The patient's condition improved post-intervention, and he was discharged after two weeks.

Conclusion: This case emphasizes the diagnostic and management challeng-es posed by simultaneous fungal and bacterial infections in neonates. Co-infections can complicate clinical presentations, prolong hospitalization, and necessitate rigorous diagnostic and therapeutic strategies. Accurate identifi-cation of pathogens and the selection of appropriate antimicrobial agents are imperative for effective management. Despite a successful outcome in this instance, the absence of follow-up underscores the necessity for con-sistent post-discharge monitoring, particularly in vulnerable populations. Continued research is essential to better understand these co-infections and improve clinical outcomes in neonatal care.

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