International Journal of Clinical Pediatrics最新文献

{"title":"Multisystem Inflammatory Syndrome Related to COVID-19 in Children","authors":"I. Brook","doi":"10.14740/ijcp389","DOIUrl":"https://doi.org/10.14740/ijcp389","url":null,"abstract":"Pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) (PIMS-TS) is a rare but serious complication of coronavirus disease 2019 (COVID-19). Reports of PIMSTS started appearing around the world in the months after the pandemic began [1]. Two recent studies totaling 75 pediatric patients published in JAMA showed that PIMS-TS is novel and different from Kawasaki disease (KD) and toxic shock syndrome (TSS) [2, 3]. The study by Whittaker et al [2] characterized the clinical features of 58 children with PIMS-TS admitted to eight hospitals in UK from March 23 to May 16, 2020. The other study by Cheung et al [3] described 17 children and adolescents admitted to a single children’s hospital in New York City with COVID-19, who developed PIMS-TS with features overlapping but identical to those of KD from April 18 to May 5, 2020. In the study by Whittaker et al [2] patients’ clinical features were compared with those of children diagnosed as having KD or KD shock syndrome [4]. Forty-five of 58 patients (78%) had evidence of current or previous infection with the SARS-CoV-2 that causes COVID-19. Thirty-three (57%) were females, and 40 (69%) were black or Asian. Most children had been previously healthy, and only seven had an underlying condition such as asthma or epilepsy. All had signs of inflammation, including elevated levels of C-reactive protein, ferritin, and neutrophils. All 58 patients had fever, 31 (53%) had abdominal pain, 30 (52%) had a rash, 26 (45%) had conjunctivitis, 29 (50%) developed shock and needed supportive drugs or fluids, 17 (29%) had mucus membrane changes and cracked lips, 15 (26%) had headache, nine (16%) had enlarged lymph nodes, 13 (22%) had kidney damage, nine (16%) had swollen hands and feet, eight (14%) had dilated coronary arteries or aneurysms, and six (10%) had a sore throat. Four patients (7%) developed abnormal heart rhythms. Twenty-five (43%) required mechanical ventilation, and two (3%) needed extracorporeal membrane oxygenation for severe heart dysfunction. Thirteen individuals met the American Heart Association criteria for KD [5], and 23 had fever and inflammation without characteristics of shock or KD. When compared with children with KD and TSS, PIMS-TS patients were older (median age: 9 vs. 2.7 years in KD and 3.8 years in TSS), and had elevated levels of C-reactive protein. Whittaker et al [2] identified three unique features for presentations of PIMS-TS: 1) Persistent fever and high levels of inflammatory markers without features of KD, shock, or organ failure; 2) Characteristic signs and symptoms of KD; 3) Shock and clinical, echocardiographic, and lab evidence of heart damage. They identified a pattern of cytokine expression that suggested an interferon signaling component, along with interleukin (IL)-6 and IL-10 production, similar to the one observed in KD and acute pulmonary COVID-19 infection. They concluded that the absence of elev","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"81 1","pages":"65-66"},"PeriodicalIF":0.0,"publicationDate":"2020-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84296363","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Challenges and Pitfalls in the Diagnosis and Management of Non-IgE Cow’s Milk Protein Allergy: Two Cases","authors":"N. Nicolaou, A. Latiff, U. Kudla, L. Muhardi","doi":"10.14740/ijcp375","DOIUrl":"https://doi.org/10.14740/ijcp375","url":null,"abstract":"As the incidence of cow’s milk protein allergy (CMPA) has increased in the last decades in both breastfed and formula fed infants, possible pitfalls in its diagnosis and management are also increasing. This is especially evident in non-IgE milk allergy due to the considerable delay between the appearance of clinical symptoms after ingestion of the allergen, and the non-specific gastrointestinal symptoms that characterize it. The misdiagnosis could often be combined with inappropriate use of either partially hydrolyzed or amino acid-based infant formula for the management of symptoms. The aim of the paper is to present two cases to illustrate common pitfalls in diagnosis and management of CMPA with divergent gastrointestinal syndrome manifestations: food protein-induced allergic proctocolitis and food protein-induced enterocolitis syndrome, in an effort to increase awareness of these conditions and to guide clinicians in day-to-day practice when facing suspected cases of CMPA. Int J Clin Pediatr. 2020;9(3):98-102 doi: https://doi.org/10.14740/ijcp375","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"1 1","pages":"98-102"},"PeriodicalIF":0.0,"publicationDate":"2020-06-29","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88226453","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Hypereosinophilia as a Presenting Symptom of Acute Lymphoblastic Leukemia in a Child","authors":"B. Avramova, I. Vlahova, A. Banchev, Konstantin N. Bachvarov, D. Stoyanova, D. Konstantinov","doi":"10.14740/ijcp365","DOIUrl":"https://doi.org/10.14740/ijcp365","url":null,"abstract":"Hypereosinophilia is rare in children and represents primary or secondary conditions, the latter of which is associated with other diseases (parasitic infections and allergic, autoimmune, and neoplastic diseases). In small number of cases (< 1%) it is a part of the clinical presentation of acute lymphoblastic leukemia, the most common malignancy in children. More often hypereosinophilia precedes the symptoms of leukemia and hinders timely diagnosis, exposing patients in a high risk. In this report, a case of a child with acute lymphoblastic leukemia and hypereosinophilia is presented. The patient is a 30-month-old female, whose leukemia is preceded 2 weeks after hypereosinophilia. This symptom made the exact and timely diagnosis of oncological disease difficult. The further course of the disease was standard despite of delayed diagnosis and incomplete induction treatment due to the hepatic chemotoxicity. We present this case due to the rarity of hypereosinophilia in pediatric acute lymphoblastic leukemia. Every experience with such cases would be very useful for the improvement of the diagnosis of these patients. Moreover in our patient we did not find typical cytogenetic or molecular genetic abnormalities for this type of leukemia, and did not observe any clinical signs of organ complications specific for hypereosinophilia. Int J Clin Pediatr. 2020;9(2):59-63 doi: https://doi.org/10.14740/ijcp365","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"24 1","pages":"59-63"},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"86058076","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Autoimmune Hepatitis With Severe Hypergammaglobulinemia and Eosinophilia in a Child","authors":"S. Makino, Motokazu Nishikado, Hitoshi Awaguni, K. Okumura, Jun Shinozuka, S. Imashuku","doi":"10.14740/ijcp372","DOIUrl":"https://doi.org/10.14740/ijcp372","url":null,"abstract":"We report here a 7-year-old Afghan girl with autoimmune hepatitis (AIH). Because she showed hepatic dysfunction with markedly high serum immunoglobulin G (IgG) (5,234 mg/dL) and eosinophilia (absolute eosinophil counts: 9,547/µL) at onset, we had difficulty in diagnosing this case by differentiating from various possible diseases. After wedge biopsy of the liver which histologically showed chronic hepatitis pattern as well as high titers (1:640) of anti-nuclear antibody with other negative autoantibodies, the patient was eventually diagnosed as AIH type 1 and successfully managed with a combination of prednisolone (PSL), azathioprine and ursodeoxycholic acid (UDCA), followed by a maintenance therapy with PSL, cyclosporine and UDCA. Int J Clin Pediatr. 2020;9(2):50-54 doi: https://doi.org/10.14740/ijcp372","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"11 1","pages":"50-54"},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88695299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"SARS-CoV-2 in a Pediatric Patient Requiring Mechanical Ventilation and Multi-Drug Therapy","authors":"Elliott S Gordon, M. Dinerman","doi":"10.14740/ijcp370","DOIUrl":"https://doi.org/10.14740/ijcp370","url":null,"abstract":"Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a novel viral pathogen that was found to disproportionately affect older adults, often sparing pediatric patients from moderate to severe illness. We report on a case of a 12-year-old patient admitted through the emergency department with bilateral pneumonia, thrombocytopenia and hematuria, who subsequently developed respiratory failure requiring intubation and mechanical ventilation. The patient was found to be SARS-CoV-2-positive. The patient’s management strategy is discussed. Int J Clin Pediatr. 2020;9(2):41-49 doi: https://doi.org/10.14740/ijcp370","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"31 1","pages":"41-49"},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89189152","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Functional Abdominal Pain in Relation to Behavioral Pattern Triggers in Children","authors":"D. Kesavelu, K. Pai, K. Veligandla","doi":"10.14740/ijcp371","DOIUrl":"https://doi.org/10.14740/ijcp371","url":null,"abstract":"Background: Functional abdominal pain (FAP) in children is a common problem encountered by clinicians. The etiology of FAP is multifactorial and this study explains the correlates of FAP to certain behavioral patterns in children. This is the first Indian study which looks into this area. Methods: Eighteen participants between 4 and 18 years old who had consulted pediatric gastroenterologist with abdominal pain in one single multi-specialty hospital were included. A written consent was obtained from parents. The Child Behavior Checklist (CBCL) was given to the parents to understand the various behavioral problems in the children; and intelligence quotient (IQ) assessments were done in all children. A 5-point Likert scale was used to assess anxiety in children which was rated by the child. Results: The CBCL identified the stressors reported by children such as academic pressure, difficulty to comprehend, need for affection from parents, interpersonal problems at home (frequent arguments between parents, comparison with a brighter sibling) and poor self-esteem. It is observed that 11/18 (61%) children had average or above average IQ and 7/18 (39%) children had low average or dull IQ. The anxiety levels of children in majority, 16 out of 18 children (88.8%) who presented with FAP, were found to be high or very high on a Likert scale. Conclusions: Children with FAP have variable IQ levels and high anxiety levels. The need for clinicians to counsel parents and children in order to address the stressors at home and school is warranted as this may help in management of FAP in children. Further multi-centric research is necessary to understand these findings in Indian children. Int J Clin Pediatr. 2020;9(2):31-34 doi: https://doi.org/10.14740/ijcp371","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"22 1","pages":"31-34"},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"72549805","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Food Protein Induced Enterocolitis Syndrome Presenting With Life-Threatening Methemoglobinemia: A Case Report and Review of the Literature","authors":"A. Bahabri, J. Moradi, K. Choong, N. Pai, M. Bhatt","doi":"10.14740/ijcp366","DOIUrl":"https://doi.org/10.14740/ijcp366","url":null,"abstract":"Food protein induced enterocolitis syndrome (FPIES) can present with diarrhea, hypovolemia and electrolyte imbalance in infancy. We present a case of life-threatening methemoglobinemia in a 1-month-old infant, a rare complication of FPIES triggered by cow’s milk protein intake. A previously healthy 1-month-old boy presented with lethargy, increased work of breathing and 2-day history of vomiting. Review of systems revealed a 3-week history of diarrhea. He was lethargic, shocky and dusky, and was intubated for persistent hypoxia. His blood work revealed severe acidemia with pH of 6.95 and methemoglobin level of 66% (normal range < 3%). His methemoglobin level and clinical status normalized following volume resuscitation, packed red blood cell transfusion and prompt intravenous methylene blue administration. Further investigations revealed a diagnosis of FPIES which was managed with a hypoallergenic formula. Methemoglobinemia should be considered in young infants presenting with severe vomiting and diarrhea, secondary to dietary protein intolerance syndromes. Prompt management with methylene blue and fluid resuscitation can result in excellent prognosis, along with specific ongoing management for FPIES. Int J Clin Pediatr. 2020;9(2):35-40 doi: https://doi.org/10.14740/ijcp366","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"19 1","pages":"35-40"},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82357175","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Domperidone-Related Acute Dystonia in a Young Child With Underlying Abnormal Electroencephalogram","authors":"K. Tang, Fauzana A. Mokhti, J. Fong, Hunainah Khairul Anwar","doi":"10.14740/ijcp364","DOIUrl":"https://doi.org/10.14740/ijcp364","url":null,"abstract":"Domperidone is the preferred treatment for vomiting and gastroesophageal reflux in pediatric population. It is known to have lesser side effects compared to metoclopramide and is rarely associated with extrapyramidal side effects. We report a case of acute dystonia in a 4-year-old girl that occurred after given two doses of domperidone. She initially presented to the emergency department for persistent vomiting and treated with syrup domperidone, ranitidine and oral rehydration salts. Approximately 24 h after last dose of oral domperidone, she developed five episodes of abnormal movement, i.e. stiffness over bilateral upper and lower limbs with eye staring to one direction without blinking. Each episode lasted for less than 10 s and patient did not lose consciousness. No history of head trauma or any family history of neurological diseases was documented. Patient was admitted for workup to rule out seizure. In ward, she developed another two brief episodes of similar presentations which resolved spontaneously without any treatment. No re-occurrence of similar episodes throughout the 3 days of hospitalization was noted. Computed tomography scan of brain confirmed no acute intracranial bleed or focal brain lesion. Electroencephalogram done during subsequent clinic follow-up noted some abnormal records due to increase in slow delta activity, but parents did not consent for magnetic resonance imaging. Patient remained well on biannual follow-up without any seizure or dystonia episode. Rare adverse event involving the central nervous system should be carefully evaluated although product label for domperidone did not mention precaution of use in patients with underlying cerebral abnormalities or epilepsy. Int J Clin Pediatr. 2020;9(2):55-58 doi: https://doi.org/10.14740/ijcp364","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"35 1","pages":"55-58"},"PeriodicalIF":0.0,"publicationDate":"2020-06-18","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75098842","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Arm Swelling From Subclavian Vein Thrombosis: Factor V Leiden Mutation","authors":"Shawn Wen, Katherine N. Tom, Y. Etoom, Jonathan P. Wong, R. Moodie, I. Al-Hashmi, L. Brandão, Peter D Wong","doi":"10.14740/ijcp343","DOIUrl":"https://doi.org/10.14740/ijcp343","url":null,"abstract":"Factor V Leiden is a genetic condition that can decrease natural anticoagulant effect in response to activated protein C, increasing thromboembolic risk. We report a 17-year-old man, homozygous for the Factor V Leiden mutation, with sudden onset arm stiffness, pain and swelling caused by a deep vein thrombosis in the subclavian vein. Pediatricians should consider thromboembolic diseases in cases of spontaneous acute limb discomfort and discoloration with no obvious cause. Int J Clin Pediatr. 2020;9(1):1-3 doi: https://doi.org/10.14740/ijcp343","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"1 1","pages":"1-3"},"PeriodicalIF":0.0,"publicationDate":"2020-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78589151","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A Case of Probable Diclofenac-Induced Acute Meningism in a Healthy Adolescent","authors":"K. Tang, Y. Teoh, Hunainah Khairul Anwar, J. Fong","doi":"10.14740/ijcp358","DOIUrl":"https://doi.org/10.14740/ijcp358","url":null,"abstract":"Non-steroidal anti-inflammatory drugs (NSAIDs) and paracetamol are the common analgesics used in children who experience mild to moderate pain. NSAIDs-related case of aseptic meningitis or meningism in healthy adolescent is relatively uncommon. We report a case of an 11-year-old boy with underlying bronchial asthma who had recent intake of three doses of diclofenac (50 mg), presented with signs and symptoms mimicking acute meningism. The boy initially presented to the emergency department after he experienced throbbing headache, dizziness, nausea and persistent vomiting for about 15 times per day for the past 2 days. He did not report presence of any auditory or visual hallucination; however, he claimed to have a bit of photophobia. Signs and symptoms occurred soon after the second dose of diclofenac. Besides, he was also taking oral antibiotic Augmentin for his left epididymo-orchitis problem and famotidine for prevention of gastritis prescribed by general practitioner. Vital signs were normal, and review of systems did not find any abnormality. Neurological assessment found no significant deficit, no cerebellar sign, negative Babinski test and no sign of meningism. Patient did not have frequent fall, head trauma or any family history of neurological diseases. A provisional diagnosis of meningoencephalitis was made after review by specialist. The parents of the boy did not give consent to conduct spinal tap. Upon further examination, urgent contrast-enhanced computed tomography was done and clinical neurological assessment was not suggestive of meningoencephalitis. Antibiotics treatment for meningoencephalitis was stopped 12 h after hospitalization. Although this case was not diagnosed as aseptic meningitis, timeline of diclofenac intake, onset of symptoms, clinical manifestations and quick resolution symptoms after drug discontinuation were supportive of a temporal relationship between diclofenac and meningism. Paracetamol was given to relieve the headache, vomiting resolved after one dose of intravenous metoclopramide plus ranitidine, and patient was well throughout the 5 days in ward. This adverse effect of NSAIDs is very rare and continuous effort in pharmacovigilance can help to raise awareness among clinicians. Int J Clin Pediatr. 2020;9(1):20-23 doi: https://doi.org/10.14740/ijcp358","PeriodicalId":13773,"journal":{"name":"International Journal of Clinical Pediatrics","volume":"400 1","pages":"20-23"},"PeriodicalIF":0.0,"publicationDate":"2020-03-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84846757","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}