A 4-year-old girl with autism spectrum disorder was admitted to the hospital for further evaluation and treatment after developing a fever and her oral intake gradually decreased. The patient’s height was 91.5 cm and her weight was 14.5 kg. She did not make eye contact or respond when spoken to. Her right eyeball was cloudy due to a corneal ulcer.
She was a picky eater and only ate fries from certain fast food companies. The patient defecated while wearing a diaper. When she was 4 years old, she was diagnosed with a right corneal ulcer, a chalazion on the left upper eyelid, night blindness due to vitamin A deficiency, and was treated with antibacterial agents (Cephem type 3) and hyaluronan. I was given acid eye drops. She was managed.
At the time of transport, the patient’s temperature was 38.7°C, blood pressure 100/77 mmHg, heart rate 100 beats/min, and oxygen saturation 98% (room air). Blood test results upon admission revealed a white blood cell count of 21,600 cells/μL, a hemoglobin concentration of 10.1 g/dL, a C-reactive protein concentration of 6.57 mg/dL, and an increased inflammatory response, while a urine test revealed cloudy urine and bacteria. The existence of was revealed. . Because the patient had a history of refractory cystitis, she was prescribed 700 mg of piperacillin (50 mg/kg) for a suspected urinary tract infection.
On the 9th day of hospitalization, the patient exhibited bilateral swelling of the labia majora, primarily on the left side (Figure 1). Ultrasound revealed a subcutaneous abscess, surface echocardiography revealed fluid accumulation in the left labia majora throughout the groin, and contrast-enhanced computed tomography revealed fluid accumulation in the labia majora with contrast enhancement. I did. Therefore, the patient was diagnosed with bilateral Bartholin’s gland abscess (Figure 2), and the patient was referred to pediatric surgery and obstetrics, where incision and drainage were performed. After maximum drainage of the left labia majora abscess by puncture with an 18 G needle, the contents were submitted for culture.
Before drainage, the labia majora on both sides are swollen.
Contrast-enhanced computed tomography shows enhanced and swollen bilateral labia, indicating bilateral Bartholin gland abscesses (red arrows and yellow triangles).
The blood test results were as follows. White blood cells, 36,300 cells/μL. Hemoglobin, 8.9 g/dL; C-reactive protein, 2.57 mg/dL. Total protein, 6.4 g/dL; serum albumin, 3.1 g/dL. Ferritin, 112.2 (reference range, 3.6-114) ng/mL. Iron, 13 (40-188) µg/dL. Zinc, 40 (80-130) μg/dL. Vitamin A, 6 (97-316) IU/dL. Vitamin C, 2.9 (5.5-16.8) μg/mL. Selenium, < 2.0 (107-171) µg/L.
The patient suffered from an exaggerated inflammatory response, vitamin A and vitamin C deficiencies, and trace element deficiencies due to an unbalanced diet. Bacterial culture of the abscess yielded anaerobic gram-positive cocci (streptococci), and intravenous treatment with 1,574 mg of piperacillin/tazobactam (100 mg/kg) was initiated. continue, Streptococcus constellatus and Prevotella Vivia Detected in abscess culture.
The swelling did not decrease after puncturing the abscess. Therefore, one week after the administration of antibiotics, he underwent incision and drainage of the abscess under general anesthesia, and the wound was completely sutured to avoid dead space. The patient received 4,350 mg sulbactam/ampicillin (300 mg/kg) intravenously until the 5th postoperative day and was discharged from the hospital on the 8th postoperative day. No further postoperative blood tests were performed as the patient recovered without complications.
An outpatient examination one week after discharge revealed that the wound had healed. Three months have passed since the surgery, and no recurrence of the abscess has been observed. After being discharged from the hospital, the patient’s picky eating seemed to have diminished, but three months after the surgery, he had already returned to eating only French fries and continued treatment with nutritional supplements.
Initially, her parents showed effort to cope with her selective eating habits. However, over time, she started consuming only certain brands of fries and sticking to certain places and dishes in her diet. There was a need to address children’s behavior and provide support to families facing similar challenges in society before they fell into further malnutrition-related illnesses. Hospitalization has made it easier for parents to understand the impact on their child’s health and to monitor nutritional status by administering supplements and assessing trace elements and vitamins if necessary.
