The journey to 'regain' life for a 14-year-old girl

(Chinhphu.vn) - A 14-year-old female patient was recently diagnosed with Systemic Lupus Erythematosus (SLE), hospitalized in a critical condition of hemoptysis, circulatory failure, and severe anemia. This is a rare manifestation, occurring in only 2% of SLE cases in children.

The rescue of the child once again affirms the courage and high level of expertise of the medical team at Bach Mai Hospital in handling dangerous and complicated cases.

Dr. Pham Cong Khac - one of the doctors directly involved in resuscitation of the child at the Pediatric Center, Bach Mai Hospital said that the child was brought to the hospital in critical condition: coughing up blood, respiratory failure, circulatory failure, severe anemia.

Chest computed tomography image shows lesions suggestive of diffuse alveolar hemorrhage.

Life and death diagnosis

Previously, the child had just been diagnosed with Systemic Lupus Erythematosus (SLE), treated at another central hospital and was discharged. After 3 days, the child began to cough up fresh red blood continuously with little phlegm and a fever of 37.5 - 38 degrees Celsius.

After several hours, the child had difficulty breathing and was very tired. His family took him to the emergency room at the Pediatric Center, Bach Mai Hospital in a state of respiratory failure (SpO2 80%), circulatory failure (cold limbs, pulse 150 beats/minute, blood pressure 90/60 mmHg) and severe anemia (hemoglobin on admission: 40 g/L).

According to Dr. Pham Cong Khac, when receiving children, doctors think of the complication of diffuse alveolar hemorrhage (DAH) in SLE patients. This is a rare manifestation, only about 2% of SLE cases in children. When it occurs, DAH often progresses very quickly, causing acute respiratory failure, severe anemia and can be fatal if not treated promptly.

Dr. Mai Thanh Cong - one of the doctors managing the autoimmune patient group at the Pediatric Center shared: "If DAH treatment due to SLE is too late, the child can die quickly. But if it is pulmonary bleeding due to infection, using high doses of immunosuppressants can make the child's infection worse."

In this situation, doctors choose to treat children with high-dose methylprednisolone combined with intravenous cyclophosphamide. This is the classic choice for cases of severe lupus with life-threatening organ damage.

Making this decision requires careful consideration of risks and benefits, especially in a 14-year-old patient. Risks include bone marrow suppression, infection, and reproductive toxicity. However, the greatest benefit is to save the patient's life in the acute phase and control the disease activity of lupus.

Pediatric patients receive respiratory support with non-invasive ventilation

Happiness burst

On the fifth day after the child's treatment, the doctors were "overwhelmed" with joy when receiving positive results from the child's treatment. The child no longer had difficulty breathing and stopped coughing up blood, did not need ventilator support, and in particular, the child's fever stopped after being treated with immunosuppressants.

At this moment, the medical team felt relieved knowing that the diagnosis and treatment decision were correct, and the patient had overcome the critical stage.

According to Dr. Cong, the special features that contributed to the success of this case include: early identification of an extremely rare but life-threatening complication (diffuse alveolar hemorrhage in systemic lupus erythematosus), even before bronchoscopy could be performed.

Differentiating diffuse alveolar hemorrhage from infectious pulmonary hemorrhage in a patient receiving immunosuppressive drugs is an extremely important step in treatment because the management approaches are completely different.

In addition, the doctors acted quickly and decisively, helping to save the child with multiple organ failure. The close coordination between specialist groups (Resuscitation - Immunology - Nephrology - Respiratory) in the same Pediatric Center also contributed to this success.

Sharing about this case, Dr. Nguyen Thanh Nam, Director of the Pediatric Center, said that this case is a typical example showing the complexity and danger of systemic lupus erythematosus in children, especially the complication of diffuse alveolar hemorrhage (DAH) - an extremely rare complication with a mortality rate of up to 50%.

The baby's miraculous recovery is not only a joy for the family but also a source of pride for the medical team at the Pediatric Center. This case has provided doctors with valuable experience, to continue improving their capacity in handling complex, rare cases.

Associate Professor, Dr. Dao Xuan Co, Director of Bach Mai Hospital, emphasized that this case is not only a medical achievement but also a great source of motivation, giving us more strength to continue to strive, improve the quality of medical examination and treatment, worthy of the trust of the people and the position of a final-level hospital. The hospital is committed to continuing to invest in research, training and further professional development to bring the best treatment to patients.

Hien Minh

Source: https://baochinhphu.vn/hanh-trinh-gianh-lai-su-song-cho-be-gai-14-tuoi-102250707144056052.htm