EC Paediatrics

Introduction: Type 1 diabetes mellitus (T1DM) is the most common metabolic disorder occurring in childhood with significant morbimortality. Uncontrolled diabetic patients are exposed to fatal hyperglycemic emergencies such as Diabetic ketoacidosis (DKA) characterized by hyperglycemia, acidosis, and ketosis. Although infections remain the predominant precipitating factors for (DKA), its association with mediastinitis is, to date, a rare situation. The objective of this study was to bring the importance of diagnosing the underlying etiological precipitants during DKA to enhance the management of this complication and reduce its mortality.

Case Description: The authors report during this article the case of a 7-year-old male patient, known type 1 diabetic on insulin therapy for 3 years, admitted to the pediatric intensive care unit in Abderrahim Harrouchi hospital in Casablanca for severe diabetic ketoacidosis with febrile reparatory distress and whom the non-improvement of the symptomatology leads us to diagnose an acute mediastinitis complicating its fungal bronchopneumonia.

Discussion: This report will review the precipitant factors, relayed by literature, associated with acute metabolic decompensation of diabetes in pediatric patients and the incidence of fungal lung infection in the diabetic population.

The authors also highlight the lack of scientific data concerning the mediastinitis complicating pulmonary infections, especially in the pediatric population.

Conclusion: Acute mediastinitis is a serious medical condition, commonly misdiagnosed due to the polymorphic and unspecific clinical presentation that can be related to the bronchopneumonia itself. This fatal complication being an etiological factor of a DKA considerably increases its mortality.

Keywords: Diabetic Ketoacidosis; Mediastinitis; Candida Pneumonia; Case Report

1. Mayer-Davis EJ., et al. “ISPAD Clinical Practice Consensus Guidelines 2018: Definition, epidemiology, and classification of diabetes in children and adolescents”. Pediatric Diabetes27 (2018): 7-19.
2. Umpierrez GE and Kitabchi AE. “Diabetic ketoacidosis: risk factors and management strategies”. Endocrinology Treatments2 (2003): 95-108.
3. Usher-Smith JA., et al. “Factors associated with the presence of diabetic ketoacidosis at diagnosis of diabetes in children and young” (2017).
4. Konstantinov NK., et al. “Respiratory failure in diabetic ketoacidosis”. World Journal of Diabetes8 (2015): 1009-1023.
5. Hansen LA., et al. “Pulmonary complications in diabetes mellitus”. Mayo Clinic Proceedings 64 (1989): 791-799.
6. Case records of the Massachusetts General Hospital. Weekly clinicopathological exercises. “Case 36-1987. A 14-year-old girl with diabetic ketoacidosis and pneumonitis with cavitation”. The New England Journal of Medicine 317 (1987): 614-623.
7. Passi GR., et al. “Recovery from pulmonary mucormycosis and candidiasis in diabetic ketoacidosis”. Indian Pediatrics 33 (1996): 1047-1050.
8. Rodrigues CF., et al. “Candida Infections in Patients with Diabetes Mellitus”. Journal of Clinical Medicine 8.1 (2019): 76.
9. Kappus S and King O. “Mediastinitis”. In: Stat Pearls Treasure Island (FL): Stat Pearls Publishing (2022).
10. Mohsenifar Z., et al. “Candida pneumonia: experience with 20 patients”. Western Journal of Medicine3 (1979): 196-200.
11. Vélez L., et al. “Diagnostic accuracy of bronchoalveolar lavage samples in immunosuppressed patients with suspected pneumonia: analysis of a protocol”. Respiratory Medicine10 (2007): 2160-2167.