Abstract: PUB317
A Case of Pulmonary Embolism and Splenic Infarct in a Child with Steroid-Resistant Nephrotic Syndrome
Session Information
Category: Pediatric Nephrology
- 1900 Pediatric Nephrology
Authors
- Reyes, Cynthia Annette, Texas Tech University Health Sciences Center El Paso Paul L Foster School of Medicine, El Paso, Texas, United States
- Khin, Ei E., Texas Tech University Health Sciences Center El Paso Paul L Foster School of Medicine, El Paso, Texas, United States
Introduction
Pulmonary embolism (PE) is a life-threatening complication more common in children with steroid-resistant nephrotic syndrome (SRNS) due to severe proteinuria and disturbances in the coagulation cascade. Intra-abdominal vein thrombosis occurs in 4.8% of children with NS however incidence of splenic infarct (SI) is unknown.
Case Description
A seven-year-old girl with SRNS on tacrolimus presented to the ED a day after six days in the hospital with chest pain and palpitations. Labs result shown in (Table 1). STAT CTA detected PE and incidental SI (Figures 1-2). She was started on a Heparin drip and Rituximab infusions. Discharged on Lovenox. Follow-up imaging showed resolution of PE.
Discussion
PE requires a high index of suspicion and delay in diagnosis worsens morbidity and mortality. This case emphasizes the importance of prompt recognition in PE symptoms, diagnosis via CTA, and initiating anticoagulants can be life-saving. Furthermore, it reports a combined finding of SI to contribute to a paucity in literature.
Investigations
| Investigation | Patient's value | Reference range |
| Troponin | 0.077ng/mL | 0-0.034ng/mL |
| NT-proBNP | 6930pg/mL | 0-300pg/mL |
| APTT | 51.8s | 23-38.6s |
| D-Dimer | 8.91μg/mL | 0-0.50μg/mL |
| Sodium | 129mmol/L | 135-145mmol/L |
| Albumin | 1.6g/dL | 3.5-5g/dL |
| 24hr urine protein | 5412mg/day | 42-225mg/day |
Acute occlussive PTE (arrow)
Splenic Infarct (arrow)