Kadriye ÖZDEMİR, Nida DİNÇEL, Orhan Deiz KARS, Ebru YILMAZ, Gözde GÖZÜOĞLU, Sevgi MİR

Çoklu organ yetersizliğine yol açan meningokoksemili olguda tedavi seçiminin sağkalım üzerine etkisi

Meningokoksemi, çoklu organ yetersizliğine (ÇOY) neden olması ve fatal seyri nedeni ile mortalitesi yüksek bir has- talıktır. Bu yazıda Meningokoksemi -ÇOY tanısıyla sürekli venö-venöz hemodiyafiltrasyon (CVVHDF) uygulanan ve böbrek fonksiyon kaybı 4 haftadan uzun sürdüğü halde kalıcı hasar gelişmeyen olgumuzu sunduk. Üç yaşında kız hasta bilinç kapalı, spontan solunumu yok, kan ba- sıncı 50/30 mmHg, yaygın ekimoz- purpurik döküntü ile yatırıldı. Laboratuvar bulgusu olarak, beyaz küre 19,600/ mm3 , hemoglobin 5,7 g/dl, trombosit sayısı 76,000/mm3 , protrombin zamanı 23,9 sn, aPTZ ölçüm dışı, serum kreatinin 7,2 mg/dl, ALT/AST 378/714 U/L olup, anürik idi. Meningokoksemi ve ÇOY tanısıyla olguya CVVHDF başlandı. Tedavinin 48. saatinde vital bulguları düzeldi, 55.saatinde ÇOYnde- böbrek hariç- gerileme oldu ve CVVHDF tedavisi kesildi. Böbrek hasarlanmasının deva- mı nedeniyle 3 saat/gün hemodiyaliz uygulandı. Yatışının ilk haftası sonunda hemodiyaliz ihtiyacı 3 gün/haftaya, 5.haftasında 2 gün/haftaya düşen ve 6. haftanın başında tamamen kalkan olgu, bir hafta daha serviste diyaliz des- teği almadan izlendi. Son kontrolünde boy- vücut ağırlığı, kan basıncı, kreatinin klirensi, idrar ozmolaritesi ve prote- in atılımı normal değerlerde olan olgu 4,5 yıldır sorunsuz izlenmektedir.

Effect of treatment choice on survival in a case with meningococcemia and multiorgan failure

We report in this paper a case had continuous veno- venous hemodiafiltration (CVVHDF) with the diagnosis of meningococcemia - multiple organ failure (MOF) and without permanent damage development although it took more than 4 weeks of loss of kidney function. Three-year- old female patient was hospitalized for unconsciousness, no spontaneous respiration, blood pressure 50/30 mmHg, and widely echimotic- purpuric rash. In her laboratory. there were 19.600 / mm3 white blood cells, 5.7 g / dL he- moglobin, 76,000 / mm3 platelets, prothrombin time was 23.9 seconds, aPTT was higher than measurable values, creatinine was 7.2 mg / dL, ALT / AST were 378/714 / L, and she was anuric. She underwent CVVHDF treatment with the diagnosis of meningococcemia and MOF. On the 48 hours of treatment, her vital signs were improved, on 55 hours MOF was revealed except for renal functions and CVVHDF treatment was discontinued. Because of the damage to the kidneys continue, she had 3 hours/ day dose of hemodialysis. At the end of hospitalization for 1 week, her hemodialysis need was declined to 3 days/ week, on 5th week to 2 days / week and on the beginning of 6 weeks, there was entirely no need for dialysis and she had been seen in services in one more week with- out dialysis need. On the last visit, she had normal blood pressure, creatinine clearance, urine osmolarity and pro- tein excretion. She was followed up for 4.5 years with no abnormality.

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