Case Reports in Pediatrics The latest articles from Hindawi Publishing Corporation © 2016 , Hindawi Publishing Corporation . All rights reserved. Ischemic Stroke in Confederation with Trivial Head Trauma Sun, 29 May 2016 14:15:03 +0000 Minor head injuries in children are common, resulting in brain concussion, and these injuries mostly end up without complications. Usually head trauma results in hemorrhagic stroke. Here we present a case of ischemic stroke following a trivial head trauma. A 10-month-old girl presented with posttraumatic right sided hemiparesis with right sided facial palsy. MRI brain revealed an area of acute infarct in the left capsuloganglionic region. The child was initially managed conservatively, as the hematological parameters were normal, and was started on anticoagulant therapy. An improvement in the clinical condition was achieved in 12 hrs of treatment with gain in power and resolution of weakness in 10 days. The specific cause for hemiparesis in the child is not elicited; possibility of genetic and environmental factors can be attributable. Archana Balachandran, Siddarameshwar Kalyanshettar, Shankargouda Patil, and Vijaykumar Shegji Copyright © 2016 Archana Balachandran et al. All rights reserved. Follicular Bronchiolitis in a Nigerian Female Child: A Case Report and Review of the Literature Thu, 26 May 2016 14:15:33 +0000 Small airways diseases are not uncommon in childhood. They account for about 28.4% of hospital admissions for lower respiratory tract infections in South West Nigeria, most of which are due to respiratory syncytial virus (RSV) infection. Noninfectious causes of small airways diseases, on the other hand, are poorly recognized and rarely feature in the differential diagnoses of chronic/recurrent lower respiratory tract disease in our environment. We present a case of follicular bronchiolitis in a 2.5-year-old Nigerian female who had left upper lobectomy on account of recurrent cough and progressive shortness of breath. Nzechukwu Zimudo Ikeri, Godwin O. Umerah, Christopher Emeka Ugwu, Olugbenga Olusoji, Adekunle Adeyomoye, Ekanem Ekure, and Adetola Olubunmi Daramola Copyright © 2016 Nzechukwu Zimudo Ikeri et al. All rights reserved. Cloacal Exstrophy Repair with Primary Closure of Bladder Exstrophy: A Case Report and Review of Literature Mon, 23 May 2016 12:30:05 +0000 Cloacal exstrophy is the most complex congenital, ventral, abdominal wall defect. Traditionally surgery consists of a staged approach to repair which takes place on many separate theatre visits. In this case a primary approach was undertaken resulting in a relatively short inpatient stay and a reduced risk from multiple surgical procedures under general anaesthesia. George Bethell, Navroop Johal, and Peter Cuckow Copyright © 2016 George Bethell et al. All rights reserved. A Case of Apparent Life-Threatening Event: Comorbid Gastric Volvulus Associated Gastroesophageal Reflux Disease and Epilepsy in a 4-Month-Old Boy Thu, 12 May 2016 08:14:09 +0000 Most isolated episodes of apparent life-threatening events (ALTEs) do not lead to the diagnosis of serious conditions, and their prognoses are generally benign. However, recurrent ALTEs are often associated with a risk of future serious adverse events and should be evaluated for appropriate management. Here we present ALTE case in which gastric volvulus associated gastroesophageal reflux disease was detected as an etiology initially, followed by the detection of epilepsy as another etiology. Clinicians should consider possibility of two or more etiologies in a single recurrent ALTE case. Yoshihiko Takano, Masaki Horiike, Ako Tatsumi, Haruko Sakamoto, Hisanori Fujino, and Shin-ichi Sumimoto Copyright © 2016 Yoshihiko Takano et al. All rights reserved. Hydropneumothorax in Children: A Rare Complication of a Bacterial Pneumonia Mon, 09 May 2016 12:03:24 +0000 Hydropneumothorax is an uncommon presentation of a complicated pneumonia, and very few cases in the pediatric population have been reported. This is a case of a 5-month-old patient who presented to the emergency department (ED) with a three-day history of fever, diarrhea, and respiratory distress. His initial assessment suggested a lower respiratory tract infection and because of his respiratory distress and hypoxia a chest X-ray was performed. Other clinical information and radiologic studies will be discussed further, but his chest X-ray suggested a right-sided hydropneumothorax secondary to a complicated pneumonia. He completed 12 days of IV antibiotic treatment and required a chest tube for drainage. Patient was discharged home with a full recovery. Carolina Ortega, Carla Gonzales, Manuel E. Soto-Martinez, and Adriana Yock-Corrales Copyright © 2016 Carolina Ortega et al. All rights reserved. Solitary Myofibroma of the Bladder Trigone in a 3-Month-Old Patient: First Case Report Tue, 03 May 2016 08:50:01 +0000 Visceral solitary myofibromas are uncommon in childhood. We report a case of a solitary asymptomatic visceral myofibroma of the bladder trigone occurring in a 3-month-old boy. Once malignancies were ruled out by cystoscopy, radical excision was performed in order to avoid any potential impairment of bladder dynamic. Postoperative course was uneventful and patient was discharged on day 3 after surgery. After 36 months of follow-up, the patient is toilet-trained and remains well; bladder function is normal. Marco Pensabene, Fortunato Siracusa, Vito Rodolico, Giuseppe Li Voti, Elisa Zambaiti, and Marcello Cimador Copyright © 2016 Marco Pensabene et al. All rights reserved. Huge Congenital Segmental Dilatation of the Sigmoid Colon in a Neonate: A “Rarity to Meet” and a “Challenge to Treat” Thu, 28 Apr 2016 14:07:17 +0000 Only ten cases of neonatal congenital segmental dilatation (CSD) of the colon have been described so far. We present a full-term female newborn with trisomy 21, ventricular septal defect, and gross abdominal distension. Plain abdominal radiographs revealed a huge cystic lesion occupying the left hemiabdomen. Upon laparotomy on day 4 a CSD of the distal sigmoid and proximal rectum was confirmed and resected. The proximal colon was exteriorized and the distal part closed as a Hartmann pouch. Histology confirmed a huge segmental dilatation of the sigmoid without dysganglionosis or pseudodiverticula, but normal intestinal architecture. After correction of the ventricular septal defect a low rectal end-to-end anastomosis could be performed at an age of 5 months. The postoperative course was uneventful. CSD of the sigmoid colon is extremely “rare to meet” and a “challenge to treat” in the newborn period, but clinical awareness of this entity prompts pediatric surgical success. Margarita Kaiser, Christoph Castellani, Georg Singer, Robert Marterer, Manfred Ratschek, and Holger Till Copyright © 2016 Margarita Kaiser et al. All rights reserved. Sporadic Burkitt Lymphoma Presenting as Acute Pancreatitis, Concurrent Sinusitis, and Enlarged Adenoids Sun, 24 Apr 2016 13:23:32 +0000 Pancreatitis and sinusitis as presentations of Burkitt lymphoma are uncommon and rarely described in children. We describe here the case of a child who presented with symptoms suggestive of sinusitis unresponsive to antibiotics, with subsequent development of abdominal symptoms due to pancreatitis. He was eventually diagnosed with Burkitt lymphoma. Vasudha Mahajan, You-Wen Qian, Brooke Blake, Yesenia Rojas-Khalil, Ravi S. Radhakrishnan, and Akila Muthukumar Copyright © 2016 Vasudha Mahajan et al. All rights reserved. Cerebral Salt Wasting Syndrome following Head Injury in a Child Managed Successfully with Fludrocortisone Sun, 24 Apr 2016 13:10:02 +0000 Cerebral salt wasting (CSW) syndrome is an important cause of hyponatremia in head injuries apart from syndrome of inappropriate antidiuretic hormone (SIADH). Proper diagnosis and differentiation between these two entities are necessary for management as the treatment is quite opposite in both conditions. Fludrocortisone can help in managing CSW where alone saline infusion does not work. We report a 17-month-old female child with head injury managed successfully with saline infusion and fludrocortisone. Nagendra Chaudhary, Santosh Pathak, Murli Manohar Gupta, and Nikhil Agrawal Copyright © 2016 Nagendra Chaudhary et al. All rights reserved. Acute Alithiasic Cholecystitis and Human Herpes Virus Type-6 Infection: First Case Wed, 20 Apr 2016 06:51:26 +0000 A three-year-old male child presented with erythematous maculopapular nonpruritic generalized rash, poor feeding, vomiting, and cramping generalized abdominal pain. He was previously healthy and there was no family history of immunologic or other diseases. On examination he was afebrile, hemodynamically stable, with painful palpation of the right upper quadrant and positive Murphy’s sign. Laboratory tests revealed elevated inflammatory markers, elevated aminotransferase activity, and features of cholestasis. Abdominal ultrasound showed gallbladder wall thickening of 8 mm with a positive sonographic Murphy’s sign, without gallstones or pericholecystic fluid. Acute Alithiasic Cholecystitis (AAC) was diagnosed. Tests for underlying infectious causes were negative except positive blood specimen for Human Herpes Virus Type-6 (HHV-6) by polymerase chain reaction. With supportive therapy the child became progressively less symptomatic with gradual improvement. The child was discharged on the sixth day, asymptomatic and with improved analytic values. Two months later he had IgM negative and IgG positive antibodies (1/160) for HHV-6, which confirmed the diagnosis of previous infection. In a six-month follow-up period he remains asymptomatic. To the best of our knowledge, this represents the first case of AAC associated with HHV-6 infection. Maria Miguel Gomes, Henedina Antunes, Ana Luísa Lobo, Fernando Branca, Jorge Correia-Pinto, and João Moreira-Pinto Copyright © 2016 Maria Miguel Gomes et al. All rights reserved. Successful Treatment of Bacillus cereus Bacteremia in a Patient with Propionic Acidemia Tue, 19 Apr 2016 14:06:43 +0000 Bacillus cereus can cause serious, life-threatening, systemic infections in immunocompromised patients. The ability of microorganism to form biofilm on biomedical devices can be responsible for catheter-related bloodstream infections. Other manifestations of severe disease are meningitis, endocarditis, osteomyelitis, and surgical and traumatic wound infections. The most common feature in true bacteremia caused by Bacillus is the presence of an intravascular catheter. Herein, we report a case of catheter-related bacteremia caused by B. cereus in a patient with propionic acidemia. Fatma Deniz Aygun, Fatih Aygun, and Halit Cam Copyright © 2016 Fatma Deniz Aygun et al. All rights reserved. Reticulated, Hyperchromic Rash in a Striated Pattern Mimicking Atopic Dermatitis and Fungal Infection in a 2-Month-Old Female: A Case of Incontinentia Pigmenti Tue, 19 Apr 2016 09:23:50 +0000 We present a 12-month-old Hispanic female with a reticulated, hyperchromic rash in a striated pattern appearing on upper and lower extremities and trunk and back since the age of 6 weeks. Over the next 10 months, the rash persisted. The rash did not respond to treatment with antifungals and steroids. During her 6-month wellness visit, the patient was diagnosed with incontinentia pigmenti (IP), a rare X-linked dominant disorder, fatal to male fetuses in utero. IP can lead to serious neurological and ophthalmologic consequences. Early diagnosis by primary care physicians and parental education about the condition are essential for prevention of retinal detachment, developmental delay, and dental abnormalities. Nina Poliak, Alexandre Le, and Anthony Rainey Copyright © 2016 Nina Poliak et al. All rights reserved. Onychomycosis due to Candida parapsilosis in a Child with Ventricular Septal Defect: An Unusual Predisposition Mon, 18 Apr 2016 07:25:49 +0000 Candida parapsilosis is emerging as a potential pathogen for onychomycosis. A 4-year-old male child with perimembranous ventricular septal defect (VSD) was admitted with features of cystitis and was treated with broad spectrum antibiotics. Two weeks later, he developed yellowish discoloration of nails of both hands. The sloughed out nail, on microscopy, showed numerous yeast forms that were identified as Candida parapsilosis by both phenotypic and genotypic methods. Antifungal sensitivity testing of the isolate was performed by microbroth dilution method in accordance with CLSI guidelines. Patient was successfully treated with topical amphotericin B and oral fluconazole. Thus, one should have a high index of suspicion of C. parapsilosis onychomycosis, especially when the patient is in the paediatric age group, presenting with unusual predisposing condition like congenital heart disease, and is on broad spectrum antibiotics. Supram Hosuru Subramanya, Deependra Hamal, Niranjan Nayak, and Shishir Gokhale Copyright © 2016 Supram Hosuru Subramanya et al. All rights reserved. Clostridium difficile Enterocolitis and Reactive Arthritis: A Case Report and Review of the Literature Thu, 14 Apr 2016 07:36:37 +0000 Reactive arthritis is a rare complication of Clostridium difficile enterocolitis, especially in children. We review the 6 pediatric cases published in the English and non-English literature and discuss their clinical presentation, outcome, treatment, and pathophysiology. We also report the seventh case of Clostridium difficile reactive arthritis in a 6-year-old boy who was treated with amoxicillin-clavulanate for 10 days because of an upper respiratory infection. After the antibiotic course, the child developed at the same time diarrhea with positive stool culture for Clostridium difficile and an asymmetric polyarthritis. Nonsteroidal anti-inflammatory drugs and metronidazole completely resolved the pain, joint swelling, and diarrhea. After twelve months of follow-up there has been no recurrence. This report confirms the self-limiting course of Clostridium difficile reactive arthritis. Clostridium difficile testing in children with gastrointestinal symptoms and acute onset of joint pain should be always considered. Michela Cappella, Fabrizio Pugliese, Andrea Zucchini, and Federico Marchetti Copyright © 2016 Michela Cappella et al. All rights reserved. Impact of Heart Transplantation on Cheyne-Stokes Respiration in a Child Tue, 05 Apr 2016 13:39:50 +0000 Sleep disordered breathing is well described in adults with heart failure but not in pediatric population. We describe a 13-year-old Caucasian male with severe heart failure related to dilated cardiomyopathy who demonstrated polysomnographic features of Cheyne-Stokes respiration, which completely resolved following cardiac transplantation. Cheyne-Stokes respiration in children with advanced heart failure and its resolution after heart transplant can be observed similar to adults. Suhail Al-Saleh, Paul F. Kantor, and Indra Narang Copyright © 2016 Suhail Al-Saleh et al. All rights reserved. Metastatic Colon Cancer in an 18-Year-Old without Predisposing Factors Sun, 27 Mar 2016 08:51:12 +0000 While colorectal carcinoma is a common gastrointestinal cancer in adults, it is rare in pediatrics with an incidence of 1 : 1,000,000 and represents a fraction of neoplasms encountered in children. Malignant neoplasms represent a major cause of mortality in the pediatric age group. While presenting with weight loss, iron deficiency, rectal bleeding, abdominal pain, and change in bowel habits, or symptoms similar to acute appendicitis, the working diagnosis may be considered to be anorexia. This case illustrates the importance of considering colon cancer among other disease entities as a cause of unintentional weight loss in adolescents. While this is a rare occurrence in the pediatric population, significant unintentional weight loss with altered bowel habits should prompt a search for underlying malignancy—even in the absence of a positive family history or predisposing cancer syndromes. Divya Mirchandani, Jolanta Kulpa, Nayaab Khawar, Israel Kochin, Pramod Narula, and Revathy Sundaram Copyright © 2016 Divya Mirchandani et al. All rights reserved. Neonatal Abdominal Hemangiomatosis: Propranolol beyond Infantile Hemangioma Sun, 27 Mar 2016 07:56:14 +0000 Hemangioma is the most common vascular tumor of infancy; presentation is often as cutaneous infantile hemangioma (IH). Cutaneous hemangioma is a clinical diagnosis. Most IHs follow a benign course, with complete involution without treatment in the majority of cases. Visceral hemangioma often involves the liver and manifests as a life-threatening disorder. Hepatic hemangiomas may be associated with high output cardiac failure, coagulopathy, and hepatomegaly which generally develop between 1 and 16 weeks of age. Mortality has been reportedly high without treatment. We report a rare case of a male infant with neonatal hemangiomatosis with diffuse peritoneal involvement, which mimicked a malignant-looking tumor on imaging, and discuss therapeutic options and efficacy. Propranolol is efficacious for IH but generally not useful for other forms of vascular hemangiomas, tumors, and malformations. In our case of neonatal peritoneal hemangiomatosis, propranolol appears to have halted the growth and possibly expedite the involution of the hemangiomatosis without other treatments. Siu Ying Angel Nip, Kam Lun Hon, Wing Kwan Alex Leung, Alexander K. C. Leung, and Paul C. L. Choi Copyright © 2016 Siu Ying Angel Nip et al. All rights reserved. Pancreatic Cystosis in Two Adolescents with Cystic Fibrosis Thu, 24 Mar 2016 11:05:22 +0000 We present pancreatic cystosis in two adolescents with cystic fibrosis, a 13-year-old girl and an 18-year-old boy. In pancreatic cystosis, which is a rare manifestation of CF, the pancreatic parenchyma is replaced with multiple cysts of different sizes. Pancreatic cystosis is mainly an imaging based diagnosis and frequent follow-up should be recommended. Elpis Hatziagorou, Asterios Kampouras, Maria Sidiropoulou, Andreas Markou, Athanasia Anastasiou, and John Tsanakas Copyright © 2016 Elpis Hatziagorou et al. All rights reserved. An Interesting Association of Cystic Hygroma of the Neck and Lymphangioma Causing a Paediatric Swollen Tongue Wed, 16 Mar 2016 07:51:44 +0000 Up to 75% of lymphatic malformations occur in the head and neck region. Of these, cystic hygromas and lymphangiomas have been widely reported; however they rarely occur in the same patient. We report the case of a 5-year-old girl who presented to the Department of Paediatrics of a district general hospital with a short history of recurrent, painful swelling of the anterior one-third of her tongue. She was reviewed under the joint care of the Oral and Maxillofacial Surgery and Otolaryngology Teams. Relevant past medical history included a previously excised cystic hygroma from her right neck when she was aged 2 years. Diagnosis of lymphangioma was made and of the potential management options available active monitoring was favoured due to the patient’s age. To our knowledge the occurrence of both tongue lymphangioma and cystic hygroma has not been previously reported in a paediatric patient. This case report therefore shows a rare association between a cystic hygroma of the neck and lymphangioma of the tongue. A. N. Beech and J. N. Farrier Copyright © 2016 A. N. Beech and J. N. Farrier. All rights reserved. Multiple Congenital Colonic Stenosis: A Rare Gastrointestinal Malformation Tue, 15 Mar 2016 16:48:06 +0000 Congenital colonic stenosis is a rare pediatric condition. Since 1968, only 16 cases have been reported in the literature. To the authors’ knowledge, multiple congenital colonic stenosis has not been previously reported in the literature. We report the case of a 2-month-old male, presented at our Neonatal Intensive Care Unit with a suspicion of intestinal malrotation. Clinical examination revealed persistent abdominal distension. During the enema examination, the contrast medium appeared to fill the lumen of the colon up to three stenotic segments and could not proceed further. Intraoperatively we confirmed the presence of four types of colonic atresia, located in the ascending, transverse, and descending colon, respectively, plus appendix atresia. First surgical steps consisted in resection of proximal stenotic segment, appendix removal, proximal cecostomy, and distal colostomy on ascending colon in order to preserve colonic length. Histopathological examination confirmed the diagnosis of colonic stenosis. Final surgical step consisted in multiple colocolostomy and enteroplasty. A planned two-stage procedure, consisting of resection with colostomy for decompression as the first step and a later anastomosis, is recommended in order to allow bowel length preservation. Zambaiti Elisa, Chiaramonte Cinzia, Salerno Sergio, Li Voti Giuseppe, and Siracusa Fortunato Copyright © 2016 Zambaiti Elisa et al. All rights reserved. Transient Creatine Kinase Elevation Followed by Hypocomplementemia in a Case of Rotavirus Myositis Sun, 13 Mar 2016 11:09:23 +0000 We report an infant case of rotavirus myositis, a rare complication of rotavirus infection. Complement levels of the patient were normal when serum creatine kinase (CK) level was at its peak and then decreased when the CK level became normalized. In a previous case report of rotavirus myositis, transient decrease of serum albumin, immunoglobulin, and complement levels was reported. The authors speculated that intravascular complement activation was caused by rotavirus and resulted in the pathogenesis of myositis, although complement levels at onset were not measured by the authors. In this report, however, we demonstrate that the complement activation of our patient is a result of, rather than the cause of, skeletal muscle damage. Yuka Rokugo, Satoru Kumaki, Ryoichi Onuma, Rie Noguchi, Saeko Suzuki, Natsuko Kusaka, Yohei Watanabe, and Setsuko Kitaoka Copyright © 2016 Yuka Rokugo et al. All rights reserved. Chronic Osteomyelitis of Clavicle in a Neonate: Report of Morbid Complication of Adjoining MRSA Abscess Tue, 08 Mar 2016 14:25:33 +0000 Osteomyelitis of clavicle is rare in neonates. Acute osteomyelitis of clavicle accounts for less than 3% of all osteomyelitis cases. It may occur due to contiguous spread, due to hematogenous spread, or secondary to subclavian catheterization. Chronic osteomyelitis may occur as a complication of residual adjoining abscess due to methicillin resistant staphylococcus aureus (MRSA) sepsis. We report a newborn female with right shoulder abscess that developed chronic clavicular osteomyelitis in follow-up period after drainage. She required multiple drainage procedures and was later successfully managed with bone curettage and debridement. We report this case to highlight that a MRSA abscess may recur due to residual infection from a chronic osteomyelitis sinus. It may be misdiagnosed as hypergranulation tissue of nonhealing wound leading to inappropriate delay in treatment. High index of suspicion, aggressive initial management, and regular follow-up are imperative to prevent this morbid complication. Shishir Murugharaj Suranigi, Manoj Joshi, Pascal Noel Deniese, Kanagasabai Rangasamy, Syed Najimudeen, and James J. Gnanadoss Copyright © 2016 Shishir Murugharaj Suranigi et al. All rights reserved. FPIES: Reviewing the Management of Food Protein-Induced Enterocolitis Syndrome Tue, 08 Mar 2016 11:25:04 +0000 Purpose of Review. The aim of this review is to provide a case driven presentation of the presenting features and diagnostic criteria particularly focusing on the management of FPIES. It also summarises the natural history and resolution of cow’s milk induced FPIES. Data Sources. OvidSP Database was used to search for literature using the keywords food protein-induced enterocolitis and FPIES. Recent Findings. The diagnosis of FPIES is often delayed following two or more presentations. Symptoms in the acute form include profuse vomiting usually 2–6 hours following ingestion of food. Vomiting may or may not be accompanied by diarrhoea. Management involves removing the causal food protein from diet. There is some concomitance in cow’s milk and soya induced FPIES. Hence extensively hydrolysed formula is the milk of choice unless breast-feeding is carried out in which case that should be continued. Summary. FPIES is a complex form of non-IgE mediated food allergy. More awareness and knowledge of the condition are required to prevent misdiagnosis. Early diagnosis and removal of the culprit food protein improve the outcome. Good nutritional advice and clear management plans are important. More multicentre studies are required to reevaluate and produce consistent oral food challenge criteria and guidelines. Neha Khanna and Kirtika Patel Copyright © 2016 Neha Khanna and Kirtika Patel. All rights reserved. Unexplained Neonatal Cardiorespiratory Collapse at Five Minutes of Age Wed, 24 Feb 2016 07:47:53 +0000 We report a case in which a term neonate suffered cardiorespiratory collapse at five minutes of age following an uncomplicated delivery and Apgar score of eight at one minute. Following prolonged cardiopulmonary resuscitation, the infant recovered well with no neurological deficit. Although sudden and unexpected postnatal collapse has been extensively described, this case does not fulfil its definition criteria. It provides a diagnostic challenge for clinicians and to the best of our knowledge is the first report of unexplained cardiorespiratory collapse at five minutes of age. The case serves as a timely reminder that cord gas analysis is recommended in all cases of potential fetal compromise and that Apgar scores should be used with caution as a predictor of neurological sequelae. Sona Zaleta, Sarah Miller, and Prashant Kumar Copyright © 2016 Sona Zaleta et al. All rights reserved. Partial Obstruction of the Endotracheal Tube by the Plastic Coating Sheared from a Stylet Tue, 16 Feb 2016 10:01:26 +0000 A preterm with gestational age of 24 weeks was intubated at day of life 16. The intubation was done in a routine manner with the use of a stylet. It took a significant effort from the clinician to pull the stylet out after intubation. After intubation the respiratory status of the neonate deteriorated requiring significantly greater support. When ventilating and oxygenating the infant was getting progressively difficult, the decision was made to change the endotracheal tube (ETT). The cause for deterioration of respiratory status was then determined to be a sheared piece of plastic from the sheath of the stylet which was lodged in the lumen of the ETT. After removal of the plastic particle, the condition of the infant improved significantly. Anirudha Das, Shwetha Chagalamarri, and Kim Saridakis Copyright © 2016 Anirudha Das et al. All rights reserved. Use of Scrambler Therapy in Acute Paediatric Pain: A Case Report and Review of the Literature Mon, 08 Feb 2016 10:06:31 +0000 We report our clinical experience on the effect of Scrambler Therapy (ST) for a child with acute mixed pain refractory to pharmacological treatment. ST, recently proposed as an alternative treatment for chronic neuropathic pain in adults, is a noninvasive approach to relieve pain, by changing pain perception at brain level. It is safe and has no side effects. Further research is needed to assess its efficacy for acute pain and for paediatric population. Sabrina Congedi, Silvia Spadini, Chiara Di Pede, Martina Ometto, Tatiana Franceschi, Valentina De Tommasi, Caterina Agosto, Pierina Lazzarin, and Franca Benini Copyright © 2016 Sabrina Congedi et al. All rights reserved. Colonic Necrosis in a 4-Year-Old with Hyperlipidemic Acute Pancreatitis Wed, 27 Jan 2016 09:45:17 +0000 Here we report the case of a 4-year-old male with severe acute pancreatitis due to hyperlipidemia, who presented with abdominal pain, metabolic abnormalities, and colonic necrosis. This colonic complication was secondary to the extension of a large peripancreatic fluid collection causing direct serosal autodigestion by pancreatic enzymes. Two weeks following the initial presentation, the peripancreatic fluid collection developed into a mature pancreatic pseudocyst, which was percutaneously drained. To our knowledge, this is the youngest documented pediatric case of colonic necrosis due to severe pancreatitis and the first descriptive pediatric case of a colonic complication due to hyperlipidemia-induced acute pancreatitis. Tiffany J. Patton, Timothy A. Sentongo, Grace Z. Mak, and Stacy A. Kahn Copyright © 2016 Tiffany J. Patton et al. All rights reserved. A Rare Case of Esophageal Dysphagia in Children: Aberrant Right Subclavian Artery Wed, 20 Jan 2016 16:06:04 +0000 Dysphagia is an impairment of swallowing that may involve any structures from the mouth to the stomach. Esophageal dysphagia presents with the sensation of food sticking, pain with swallowing, substernal pressure, or chronic heartburn. There are many causes of esophageal dysphagia, such as motility disorders and mechanical and inflammatory diseases. Infrequently dysphagia arises from extrinsic compression of the esophagus from any vascular anomaly of the aortic arch. The most common embryologic abnormality of the aortic arch is aberrant right subclavian artery, clinically known as arteria lusoria. This abnormality is usually silent. Here, we report a case of six-year-old child presenting to us with a history of progressive dysphagia without respiratory symptoms. A barium esophagogram showed an increase of the physiological esophageal narrowing at the level of aortic arch, while at esophagogastroduodenoscopy there was an extrinsic pulsatile compression of the posterior portion of the esophagus suggesting an extrinsic compression by an aberrant vessel. Angio-CT (computed tomography) scan confirmed the presence of an aberrant right subclavian artery. Claudia Barone, Nicolina Stefania Carucci, and Claudio Romano Copyright © 2016 Claudia Barone et al. All rights reserved. A Case of Polyarteritis Nodosa Associated with Vertebral Artery Vasculitis Treated Successfully with Tocilizumab and Cyclophosphamide Wed, 20 Jan 2016 08:58:45 +0000 Pediatric polyarteritis nodosa is rare systemic necrotizing arteritis involving small- and medium-sized muscular arteries characterized by aneurysmal dilatations involving the vessel wall. Aneurysms associated with polyarteritis nodosa are common in visceral arteries; however intracranial aneurysms have also been reported and can be associated with central nervous system symptoms, significant morbidity, and mortality. To our knowledge extracranial involvement of the vertebral arteries has not been reported but has the potential to be deleterious due to fact that they supply the central nervous system vasculature. We present a case of a 3-year-old Haitian boy with polyarteritis nodosa that presented with extracranial vessel involvement of his vertebral arteries. After thorough diagnostic imaging, including a bone scan, ultrasound, Magnetic Resonance Imaging/Angiography, and Computed Tomography Angiography, he was noted to have vertebral artery vasculitis, periostitis, subacute epididymoorchitis, arthritis, and myositis. He met diagnostic criteria for polyarteritis nodosa and was treated with cyclophosphamide, methylprednisolone, and tocilizumab, which resulted in improvement of his inflammatory markers, radiographic findings, and physical symptoms after treatment. To the authors’ knowledge, this is the first report of vertebral artery vasculitis in polyarteritis nodosa as well as successful treatment of the condition using the combination cyclophosphamide and tocilizumab for this condition. Kae Watanabe, Dhanashree A. Rajderkar, and Renee F. Modica Copyright © 2016 Kae Watanabe et al. All rights reserved. Autoimmune Hemolytic Anemia and Hodgkin’s Disease: An Unusual Pediatric Association Tue, 19 Jan 2016 12:35:13 +0000 Autoimmune hemolytic anemia (AIHA) is a recognized complication of lymphoproliferative disorders. AIHA associated with Hodgkin’s disease (HD) is uncommon especially in the pediatric population. The diagnosis of AIHA is usually associated with HD at the time of initial presentation or during the course of disease, but it could precede it by years to months. In adults the association of AIHA and HD is more frequent in advanced stages and in the nodular sclerosis and mixed cellularity type HD. Warm immune hemolytic anemia is mainly controlled with steroids and chemotherapy. We report a case of a pediatric patient with direct antiglobulin positive test at the diagnosis of a late relapse of stage III B mixed cellularity type HD. Maria Miguel Gomes, Tereza Oliva, and Armando Pinto Copyright © 2016 Maria Miguel Gomes et al. All rights reserved.