Case Reports in Pediatrics The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. An Interesting Fistula Tract Presenting with Recurrent Gluteal Abscess: Instructive Case Sun, 05 Apr 2015 08:45:17 +0000 A fistula extending from the gluteus to penis is an extremely rare entity. In this paper, we have highlighted novel variant of congenital penile to gluteal fistula complicated with gluteal and penoscrotal abscess in a previously healthy boy. A fistulous tract extending from the gluteus to penis has been shown by fistulogram. Bleomycin has been used in fistula tract with successful results in our patient. Gulsum Iclal Bayhan, Ozge Metin, Burak Ardicli, Ayse Karaman, and Gonul Tanir Copyright © 2015 Gulsum Iclal Bayhan et al. All rights reserved. Ectopic Lingual Thyroid Sun, 29 Mar 2015 11:12:37 +0000 Ectopy of the thyroid gland is an abnormal embryological development. Its occurrence in children is rare. In this study, we report the case of a 12-year-old girl that presented with dysphagia and nocturnal dyspnea. Magnetic resonance imaging confirmed the presence of a lingual thyroid. Thyroid scintigraphy showed intense and elective uptake of radiotracer at the base of the tongue. Hormonal tests revealed hypothyroidism. Treatment consisted of opotherapy based on levothyroxine. Evolution has been favourable and the patient showed significant improvement with reduction of the dyspnea and the dysphagia and normalization of thyroid hormone tests. Khaled Khamassi, Habib Jaafoura, Fahmi Masmoudi, Rim Lahiani, Lobna Bougacha, and Mamia Ben Salah Copyright © 2015 Khaled Khamassi et al. All rights reserved. Empyema Necessitans Complicating Pleural Effusion Associated with Proteus Species Infection: A Diagnostic Dilemma Sun, 29 Mar 2015 09:33:08 +0000 Background. Empyema necessitans, a rare complication of pleural effusion, could result in significant morbidity and mortality in children. It is characterized by the dissection of pus through the soft tissues and the skin of the chest wall. Mycobacterium tuberculosis and Actinomyces israelii are common causes but Gram negative bacilli could be a rare cause. However, there were challenges in differentiating between Mycobacterium tuberculosis and nontuberculous empyema in a resource poor setting like ours. We report a child with pleural effusion and empyema necessitans secondary to Proteus spp. infection. Methods. We describe a 12-year-old child with empyema necessitans complicating pleural effusion and highlight management challenges. Results. This case was treated with quinolones, antituberculous drugs, chest tube drainage, and nutritional rehabilitation. Conclusion. Empyema necessitatis is a rare condition that can be caused by Gram negative bacterial pathogens like Proteus species. M. S. Yauba, H. Ahmed, I. A. Imoudu, M. O. Yusuf, and H. U. Makarfi Copyright © 2015 M. S. Yauba et al. All rights reserved. Spontaneous Duodenal Perforation as a Complication of Kawasaki Disease Thu, 26 Mar 2015 12:25:59 +0000 Kawasaki disease is generally known as a systemic vasculitis that often concerns doctors due to its serious cardiac complications; however, other visceral organs may get involved as well. Surgical manifestations of the intestinal tract in Kawasaki disease are rare. In this report, we describe the case of a 2.5-year-old boy with typical Kawasaki disease who presented with GI bleeding and surgical abdomen. The diagnosis of duodenal perforation was confirmed. Kambiz Masoumi, Arash Forouzan, Hossein Saidi, Hazhir Javaherizadeh, Ali Khavanin, and Mohammad Bahadoram Copyright © 2015 Kambiz Masoumi et al. All rights reserved. Thoracic Block Technique Associated with Positive End-Expiratory Pressure in Reversing Atelectasis Thu, 26 Mar 2015 07:29:45 +0000 A preschool four-year-old male patient had been admitted to the Mandaqui Hospital with a diagnosis of lobar pneumonia, pleural effusion, and right lung atelectasis. Treatment consisted of antibiotics and physiotherapy sessions, using a technique described in the literature as Insufflation Technique to Reverse Atelectasis (ITRA), which consists of a thoracic block of healthy lung tissue, leaving only the atelectasis area free, associated with the use of invasive or noninvasive mechanical ventilation with positive airway pressure for reversal of atelectasis. Two physiotherapy sessions were conducted daily. The sessions lasted 20 minutes and were fractionated into four series of five minutes each. Each series bilateral thoracic block was performed for 20 seconds with a pause lasting for the same time. Associated with the thoracic block, a continuous positive airways pressure was used using a facial mask and 7 cm H2O PEEP provided via CPAP. Conclusion. ITRA technique was effective in reversing atelectasis in this patient. Luciana Carnevalli Pereira, Ana Paula de Souza Netto, Fernanda Cordeiro da Silva, Silvana Alves Pereira, and Cristiane Aparecida Moran Copyright © 2015 Luciana Carnevalli Pereira et al. All rights reserved. Treatment for Retinopathy of Prematurity in an Infant with Adenoviral Conjunctivitis Thu, 19 Mar 2015 11:43:26 +0000 Retinopathy of prematurity (ROP) has been a major problematic disorder during childhood. Laser photocoagulation (LPC) has been proven to be effective in most of the ROP cases. Adenoviral conjunctivitis (AVC) is responsible for epidemics among adult and pediatric population. It has also been reported to be a cause of outbreaks in neonatal intensive care units (NICU) several times. We herein demonstrate a case with AVC who underwent LPC for ROP. And we discuss the treatment methodology in such cases. Murat Gunay, Gokhan Celik, and Rahim Con Copyright © 2015 Murat Gunay et al. All rights reserved. Gingival Bleeding of a High-Flow Mandibular Arteriovenous Malformation in a Child with 8-Year Follow-Up Tue, 17 Mar 2015 09:07:29 +0000 Intraosseous arteriovenous malformations (AVMs) in the head and neck region are uncommon. There are several types and they can have a wide range of clinical presentations. Depending on the blood flow through the AVM, the treatment may be challenging for the attending team and may lead to life-threatening hemorrhages. A clinical case report is presented. A 9-year-old girl, seen for gingival bleeding during oral hygiene, was found to have a high-flow AVM located within and around the mandible. Two-stage treatment consisted of intra-arterial embolization followed by intraoral injection of a sclerosing agent 8 weeks later. At the 8-year follow-up, imaging study showed no evidence of recurrent lesion inside or outside the bone. The final outcome is a correct occlusion with a symmetric facial result. This case shows that conservative treatment may be the first treatment option mostly in children. Arteriography and transcortical injection were enough to control the AVM. Elvira Ferrés-Amat, Jordi Prats-Armengol, Isabel Maura-Solivellas, Eduard Ferrés-Amat, Javier Mareque-Bueno, and Eduard Ferrés-Padró Copyright © 2015 Elvira Ferrés-Amat et al. All rights reserved. Prolonged Ileus in an Infant Presenting with Primary Congenital Hypothyroidism Tue, 17 Mar 2015 08:55:37 +0000 Congenital hypothyroidism (CH) is the most common endocrine disorder affecting the newborn. Universal newborn screening (NBS) has virtually eliminated the static encephalopathy and devastating neurodevelopmental syndrome known as cretinism. This report describes the presentation of an infant referred by the primary pediatrician to our hospital at 12 days of age for confirmatory testing after the NBS was consistent with CH. The infant had hypoglycemia secondary to lethargy and poor feeding and required transfer to the neonatal intensive care unit for worsening abdominal distension despite normalization of serum thyroid function tests following hormone replacement. In particular, the recalcitrant ileus and secondary bowel obstruction resulted in an additional diagnostic workup and lengthened hospital day. Our report highlights the acute gastrointestinal consequences of hypothyroidism despite evidence of effective treatment. We believe that the preclinical detection and immediate therapy for CH have lessened the prevalence of this presentation in general practice, and hence practitioners are less likely to be familiar with its natural history and management. Caroline Chua, Shilpa Gurnurkar, Yahdira Rodriguez-Prado, and Victoria Niklas Copyright © 2015 Caroline Chua et al. All rights reserved. Therapeutic Hypothermia and Out-of-Hospital Cardiac Arrest in a Child with Hypertrophic Obstructive Cardiomyopathy Mon, 16 Mar 2015 14:10:09 +0000 Neurologic outcomes following pediatric cardiac arrest are consistently poor. Early initiation of cardiopulmonary resuscitation has been shown to have positive effects on both survival to hospital discharge, and improved neurological outcomes after cardiac arrest. Additionally, the use of therapeutic hypothermia may improve survival in pediatric cardiac arrest patients admitted to the intensive care unit. We report a child with congenital hypertrophic obstructive cardiomyopathy and an out-of-hospital cardiac arrest, in whom the early initiation of effective prolonged cardiopulmonary resuscitation and subsequent administration of therapeutic hypothermia contributed to a positive outcome with no gross neurologic sequelae. Continuing efforts should be made to promote and employ high-quality cardiopulmonary resuscitation, which likely contributed to the positive outcome of this case. Further research will be necessary to develop and solidify national guidelines for the implementation of therapeutic hypothermia in selected subpopulations of children with OHCA. Nancy Spurkeland, Gregory Bennett, Chandran Alexander, Dennis Chang, and Gary Ceneviva Copyright © 2015 Nancy Spurkeland et al. All rights reserved. Costello Syndrome with Severe Nodulocystic Acne: Unexpected Significant Improvement of Acanthosis Nigricans after Oral Isotretinoin Treatment Sat, 28 Feb 2015 12:58:43 +0000 We report the case of 17-year-old female diagnosed with Costello syndrome. Genetic testing provided a proof with G12S mutation in the HRAS gene since 3 years of age with a presentation of severe nodulocystic acne on her face. After 2 months of oral isotretinoin treatment, improvement in her acne was observed. Interestingly, an unexpected significant improvement of acanthosis nigricans on her neck and dorsum of her hands was found as well. We present this case as a successful treatment option by using oral isotretinoin for the treatment of acanthosis nigricans in Costello syndrome patients. Leelawadee Sriboonnark, Harleen Arora, Leyre Falto-Aizpurua, Sonal Choudhary, and Elizabeth Alvarez Connelly Copyright © 2015 Leelawadee Sriboonnark et al. All rights reserved. Pulmonary Epithelioid Hemangioendothelioma in a Patient with Crohn’s Disease Sat, 28 Feb 2015 11:09:02 +0000 Pulmonary epithelioid hemangioendothelioma (PEH) is a rare neoplasm, largely unresponsive to chemotherapeutic medications, and with varied prognosis. Imaging on computerized tomography may demonstrate perivascular nodules, but diagnosis is ultimately made on biopsy with immunohistochemical analysis. Here we describe a case of PEH in a 14-year-old male with Crohn’s disease, which, to our knowledge, has not previously been described in the literature. Nanda Ramchandar and Henry A. Wojtczak Copyright © 2015 Nanda Ramchandar and Henry A. Wojtczak. All rights reserved. Corrigendum to “Gitelman Syndrome in a School Boy Who Presented with Generalized Convulsion and Had a R642H/R642W Mutation in the SLC12A3 Gene” Sat, 28 Feb 2015 07:14:33 +0000 Shigeru Makino, Toshihiro Tajima, Jun Shinozuka, Aki Ikumi, Hitoshi Awaguni, Shin-ichiro Tanaka, Rikken Maruyama, and Shinsaku Imashuku Copyright © 2015 Shigeru Makino et al. All rights reserved. Systemic Steroid Treatment for Severe Expanding Pneumococcal Pneumonia Thu, 26 Feb 2015 09:17:24 +0000 The treatment of bacterial community-acquired pneumonia (CAP) is based on appropriate antibiotic therapy and supportive care such as intravenous fluids and supplemental oxygen. There is no available data regarding the use of steroids in CAP in children. We present an unusual case of a child with severe respiratory distress, on the brink of mechanical ventilation, due to a rapidly expanding pneumococcal pneumonia. The administration of systemic steroids resulted in a dramatic response with rapid improvement of clinical and radiological abnormalities followed by improvement of laboratory abnormalities. This case report should raise the awareness of the potential benefits of steroids in the treatment of severe pneumonia in children. Prospective randomized trials are needed to confirm the efficacy of steroids in this setting and to determine which patients would benefit most from this. Eran Lavi, David Shoseyov, Natalia Simanovsky, and Rebecca Brooks Copyright © 2015 Eran Lavi et al. All rights reserved. Subacute Sclerosing Panencephalitis in a Child with Recurrent Febrile Seizures Tue, 24 Feb 2015 08:15:12 +0000 Subacute sclerosing panencephalitis (SSPE) is a devastating disease of the central nervous system (CNS) caused by persistent mutant measles virus infection. The diagnosis of SSPE is based on characteristic clinical and EEG findings and demonstration of elevated antibody titres against measles in cerebrospinal fluid. Subacute sclerosing panencephalitis can have atypical clinical features at the onset. Herein, we report an unusual case of subacute sclerosing panencephalitis in a child with recurrent febrile seizures. The disease progressed with an appearance of myoclonic jerks, periodic high amplitude generalized complexes on EEG, and elevated titers of measles antibodies in cerebrospinal fluid leading to the final diagnosis of subacute sclerosing panencephalitis. Ayşe Kartal, Ayşegül Neşe Çıtak Kurt, Tuğba Hirfanoğlu, Kürşad Aydın, and Ayşe Serdaroğlu Copyright © 2015 Ayşe Kartal et al. All rights reserved. Successful Treatment with Mycophenolate Mofetil and Tacrolimus in Juvenile Severe Lupus Nephritis Tue, 17 Feb 2015 12:39:54 +0000 Lupus nephritis (LN) of juvenile onset often has severe disease presentation. Despite aggressive induction therapy, up to 20% of patients with LN are resistant to initial therapy and up to 44% suffer a renal relapse. However, there is no consensus on an appropriate therapeutic regimen for refractory LN. We report a 13-year-old girl with recurrent LN who was not taking her medications. At age of 11 years, she was diagnosed with LN classified as International Society of Nephrology/Renal Pathology Society (ISN/RPS) class IV G (A) + V. She was treated with prednisolone and MMF after nine methylprednisolone pulses. Nineteen months later, she was admitted to the hospital with generalized edema. Her symptoms were nephrotic syndrome and acute renal dysfunction. She received three methylprednisolone pulses for 3 days, followed by oral prednisolone and MMF. Twenty-seven days after the three methylprednisolone pulses, her acute renal dysfunction was improved, but the nephrotic syndrome was not improved. A second biopsy showed diffuse lupus nephritis classified as the predominant finding of ISN/RPS class V. We added tacrolimus to the MMF. Four months after adding tacrolimus, the nephrotic syndrome improved. We conclude that adding tacrolimus to the treatment regimen for LN resistant to MMF is effective. Tomoo Kise, Hiroshi Yoshimura, Shigeru Fukuyama, and Masatsugu Uehara Copyright © 2015 Tomoo Kise et al. All rights reserved. Multicentric Castleman’s Disease in a Child Revealed by Chronic Diarrhea Mon, 09 Feb 2015 06:29:31 +0000 Multicentric Castleman’s disease is a rare benign and unexplained lymphoproliferative disorder that is extremely uncommon in children. It presents with fever, systemic symptoms, generalized lymphadenopathy, and laboratory markers of inflammation. Its treatment is not standardized and its prognosis is poor. We report a novel case of multicentric Castleman’s disease in a 13-year-old girl who had presented with chronic diarrhea as the only initial presenting symptom. The diagnosis of celiac or inflammatory bowel diseases was suspected, but two and a half years later, the diagnosis of multicentric Castleman’s disease was brought following the appearance of abdominal mass whose biopsy revealed Castleman’s disease in the plasma cell form. The outcome was favorable after treatment by corticosteroid, chemotherapy, and surgery. The occurrence of diarrhea as the initial symptom of multicentric Castleman’s disease without lymph node involvement is very rare. This case report underlines the diagnostic difficulties and the long interval between onset and diagnosis when diarrhea occurs first. Sarra Benmiloud, Sana Chaouki, Samir Atmani, and Moustapha Hida Copyright © 2015 Sarra Benmiloud et al. All rights reserved. Congenital Portosystemic Shunt: Our Experience Mon, 02 Feb 2015 09:15:36 +0000 Introduction. Congenital portosystemic venous malformations are rare abnormalities in which the portal blood drains into a systemic vein and which are characterized by extreme clinical variability. Case Presentations. The authors present two case reports of a congenital extrahepatic portosystemic shunt (Type II). In the first patient, apparently nonspecific symptoms, such as headache and fatigue, proved to be secondary to hypoglycemic episodes related to the presence of a portosystemic shunt, later confirmed on imaging. During portal vein angiography, endovascular embolization of the portocaval fistula achieved occlusion of the anomalous venous tract. In the second patient, affected by Down’s syndrome, the diagnosis of a portosystemic malformation was made by routine ultrasonography, performed to rule out concurrent congenital anomalies. Because of the absence of symptoms, we chose to observe this patient. Conclusions. These two case reports demonstrate the clinical heterogeneity of this malformation and the need for a multidisciplinary approach. As part of a proper workup, clinical evaluation must always be followed by radiographic diagnosis. Tiziana Timpanaro, Stefano Passanisi, Alessandra Sauna, Claudia Trombatore, Monica Pennisi, Giuseppe Petrillo, Pierluigi Smilari, and Filippo Greco Copyright © 2015 Tiziana Timpanaro et al. All rights reserved. Severe IgG4-Related Disease in a Young Child: A Diagnosis Challenge Thu, 29 Jan 2015 08:52:04 +0000 Immunoglobulin G4-related disease (IgG4-RD) is an increasingly recognized syndrome that can appear with multiple organ involvement, typically with tumor-like swelling, lymphoplasmacytic infiltrate rich in IgG4-positive plasma cells, and elevated serum IgG4 concentrations. We report the case of a 22-month-old female child with failure to thrive and recurrent respiratory tract infections since 8 months of age. Physical examination was normal except for pulmonary auscultation with bilateral crackles and wheezes. Laboratory tests revealed elevated erythrocyte sedimentation rate, and elevated serum IgG and IgG4 with polyclonal hypergammaglobulinemia. Thoracic CT and MRI showed multiple mediastinal lymphadenopathies and a nodular posterior mediastinal mass in right paratracheal location with bronchial compression. Initial fine needle aspiration biopsy was compatible with reactive lymphadenopathy but after clinical worsening a thoracoscopic partial resection of the mass was performed and tissue biopsy revealed lymphoplasmacytic infiltrate and increased number of IgG4-positive plasma cells and a ratio of IgG4/IgG positive cells above 40%. Glucocorticoids therapy was started with symptomatic improvement, reduction in the size of the mass, and decrease of serum IgG4 levels after 6 weeks. There are very few reports of IgG4-RD in children. Long-term follow-up is necessary to monitor relapses and additional organ involvement. Susana Corujeira, Catarina Ferraz, Teresa Nunes, Elsa Fonseca, and Luísa Guedes Vaz Copyright © 2015 Susana Corujeira et al. All rights reserved. Separation of the Proximal Humeral Epiphysis in the Newborn: Rapid Diagnosis with Ultrasonography Wed, 28 Jan 2015 11:49:06 +0000 Separation of the proximal humeral epiphysis (SPHE) is a well-known occurrence and may occur secondary to trauma, infection, and nonaccidental trauma. Since most newborns do not have the proximal humeral epiphysis ossified at birth, the diagnosis may be difficult to make on routine radiographs. Ultrasonography of the shoulder in the newborn is rapid, noninvasive, and nonionizing imaging techniques which can diagnose SPHE. In this report, we describe and emphasize the diagnostic utility of state-of-the-art ultrasonography for the diagnosis of SPHE. Rachelle Goldfisher and John Amodio Copyright © 2015 Rachelle Goldfisher and John Amodio. All rights reserved. A Case of Battery Ingestion in a Pediatric Patient: What Is Its Importance? Tue, 27 Jan 2015 11:57:52 +0000 This is a case of a two-year-old boy who has been suffering from food regurgitation and frequent vomiting over the past seven months which were progressively worsening with time. He was initially diagnosed with gastroesophageal reflux disease and treated accordingly but responded only minimally. Investigations and interventional procedures including a chest X-ray showed a metallic round object in the upper esophagus consistent with a button battery which was removed via a thoracotomy after an esophagoscopy was not successful. This child would not have developed such serious complications and would not have required major surgery had the foreign body been identified and removed early on. Elie Alam, Marc Mourad, Samir Akel, and Usamah Hadi Copyright © 2015 Elie Alam et al. All rights reserved. Bilateral Symmetrical Herpes Zoster in an Immunocompetent 15-Year-Old Adolescent Boy Tue, 27 Jan 2015 08:31:45 +0000 Herpes zoster is uncommon in immunocompetent children. The bilateral symmetrical occurrence of herpes zoster lesions is extremely rare. We report a 15-year-old immunocompetent Chinese adolescent boy who developed bilateral symmetrical herpes zoster lesions. To our knowledge, the occurrence of bilateral symmetrical herpes zoster lesions in an immunocompetent individual has not been reported in the pediatric literature. Alexander K. C. Leung and Benjamin Barankin Copyright © 2015 Alexander K. C. Leung and Benjamin Barankin. All rights reserved. Liver Transplant in a Patient under Methylphenidate Therapy: A Case Report and Review of the Literature Thu, 22 Jan 2015 08:12:16 +0000 Background. Methylphenidate (MPH) is widely used in treating children with attention-deficit-hyperactivity disorder. Hepatotoxicity is a rare phenomenon; only few cases are described with no liver failure. Case. We report on the case of a 12-year-old boy who received MPH for attention-deficit-hyperactivity disorder. Two months later the patient presented with signs and symptoms of hepatitis and MPH was discontinued, showing progressive worsening and developing liver failure and a liver transplantation was required. Other causes of liver failure were ruled out and the liver biopsy was suggestive of drug toxicity. Discussion. One rare adverse reaction of MPH is hepatotoxicity. The review of the literature shows few cases of liver injury attributed to MPH; all of them recovered after withdrawing the treatment. The probable mechanism of liver injury was MPH direct toxicity to hepatocytes. In order to establish the diagnosis of MPH-induced liver injury, we used CIOMS/RUCAM scale that led to an assessment of “possible” relationship. This report provides the first published case of acute MPH-induced liver failure with successful hepatic transplantation. Conclusions. It is important to know that hepatotoxicity can occur in patients with MPH treatment and monitoring the liver’s function is highly recommended. Hoi Y. Tong, Carmen Díaz, Elena Collantes, Nicolás Medrano, Alberto M. Borobia, Paloma Jara, and Elena Ramírez Copyright © 2015 Hoi Y. Tong et al. All rights reserved. Concurrence of Meningomyelocele and Salt-Wasting Congenital Adrenal Hyperplasia due to 21-Hydroxylase Deficiency Mon, 19 Jan 2015 08:14:51 +0000 Congenital adrenal hyperplasia (CAH) is a group of inherited defects of cortisol biosynthesis. A case of classical CAH due to 21-hydroxylase deficiency (21-OHD) with early onset of salt waste and concurrence of meningomyelocele (MMC) was presented here. The management of salt-wasting crisis which is complicated by a postrenal dysfunction due to neurogenic bladder was described. Possible reasons of growth retardation in the one-year follow-up period were discussed. A significant regression of the phallus with proper medical treatment was also mentioned. Heves Kırmızıbekmez, Rahime Gül Yesiltepe Mutlu, Serdar Moralıoğlu, Ahmet Tellioğlu, and Ayşenur Cerrah Celayir Copyright © 2015 Heves Kırmızıbekmez et al. All rights reserved. Ameloblastic Fibroma of the Maxilla with Bilateral Presentation: Report of a Rare Case with Review of the Literature Mon, 05 Jan 2015 10:05:03 +0000 Ameloblastic fibroma (AF) is an uncommon benign odontogenic tumour, with both epithelial and mesenchymal neoplastic proliferation. It occurs most frequently in the posterior region of the mandible, while its occurrence in the maxilla is extremely rare. They are usually encountered in children, emphasizing it as an important diagnostic consideration. Herein, we report the first case of a bilateral maxillary ameloblastic fibroma in a 2-year-old female child patient who presented with a chief complaint of swelling in the right mid facial region. Kranti Kiran Reddy Ealla, Vijayabaskar Reddy Basavanapalli, Surekha Reddy Velidandla, Sangameshwar Manikya, Rajesh Ragulakollu, Prasanna M. Danappanavar, and Vijayasree Vennila Copyright © 2015 Kranti Kiran Reddy Ealla et al. All rights reserved. Deep Venous Thrombosis of the Leg, Associated with Agenesis of the Infrarenal Inferior Vena Cava and Hypoplastic Left Kidney (KILT Syndrome) in a 14-Year-Old Child Mon, 05 Jan 2015 09:09:15 +0000 Agenesis of the inferior vena cava (IVC) is a rare anomaly which can be identified as incidental finding or can be associated with iliofemoral vein thrombosis. IVC agenesis has a known association with renal anomalies which are mainly confined to the right kidney. We describe a case of a 14-year-old male who presented with left leg swelling and pain. Ultrasonography confirmed the presence of left leg deep vein thrombosis (DVT). No underlying hematologic risk factors were identified. A CT scan was obtained which demonstrated absent infrarenal IVC and extensive thrombosis in the left deep venous system and development of collateral venous flow into the azygous/hemiazygous system, with extension of thrombus into paraspinal collaterals. An additional finding in the patient was an atrophic left kidney and stenosis of an accessory left renal artery. Agenesis of the IVC should be considered in a young patient presenting with lower extremity DVT, especially in patients with no risk factors for thrombosis. As agenesis of the IVC cannot be corrected, one should be aware that there is a lifelong risk of lower extremity DVT. Sakshi Bami, Yarelis Vazquez, Valeriy Chorny, Rachelle Goldfisher, and John Amodio Copyright © 2015 Sakshi Bami et al. All rights reserved. Necrotizing Fasciitis of the Chest in a Neonate in Southern Nigeria Tue, 30 Dec 2014 12:29:12 +0000 We discuss the successful saving of a male neonate with necrotizing fasciitis of the chest following a hot fomentation of the umbilicus with exposure of the ribs and the pleural space on the right side. He recovered 5 weeks after admission. We stressed the need to recognize necrotizing fasciitis extending from the upper anterior abdominal wall to the chest following hot fomentation of the umbilicus. The need for multidisciplinary cooperation for excellent outcome is very important, that is, neonatologist, medical microbiologist, and plastic and chest surgeons. Oluwafemi Olasupo Awe, Emeka B. Kesieme, Babatunde Kayode-Adedeji, and Quinzy O. Aigbonoga Copyright © 2014 Oluwafemi Olasupo Awe et al. All rights reserved. Atypical Presentation of Cat-Scratch Disease in an Immunocompetent Child with Serological and Pathological Evidence Sun, 28 Dec 2014 00:10:20 +0000 Typical cat-scratch disease (CSD) is characterized by local lymphadenopathy following the scratch or bite from a cat or kitten. An atypical presentation which includes liver and/or spleen lesions is rarely reported in an immunocompetent child. Systemic CSD may mimic more serious disorders like malignancy or tuberculosis. Although a diagnosis is difficult to establish in systemic CSD, an early diagnosis and an appropriate treatment are important to prevent complications. Bartonella henselae is difficult to culture, and culture is not routinely recommended. Clinical, serological, radiological, and pathological findings are used for the diagnosis of CSD. Herein we present a case of systemic CSD presenting with hepatic mass in an immunocompetent child. The differential diagnosis is made by serological and pathological evidence. He was successfully treated with gentamicin (7.5 mg/kg) and rifampin (15 mg/kg) for six weeks. Serkan Atıcı, Eda Kepenekli Kadayıfcı, Ayşe Karaaslan, Muhammed Hasan Toper, Cigdem Ataizi Celikel, Ahmet Soysal, and Mustafa Bakır Copyright © 2014 Serkan Atıcı et al. All rights reserved. A Case of Acute Myeloid Leukemia (FAB M2) with Inversion 16 Who Presented with Pelvic Myeloid Sarcoma Mon, 22 Dec 2014 06:25:25 +0000 Acute leukemias are the most common childhood cancer in all age groups. Acute myeloid leukemias (AML) constitute about 15–20% of acute leukemias. Fatigability, pallor, fever, and bleeding are the most common presenting symptoms of AML. Hepatosplenomegaly and lymphadenopathy are commonly encountered during physical examination. In rare instances eruptions due to skin involvement and localized tumor masses (myeloid sarcoma) may be found. Myeloid sarcoma is especially seen in AML-M2 subtype. By cytogenetic analysis, in AML-M2 subtype t(8;21) is often seen and it is more probable to find inversion 16 in AML-M4Eos subtype. Herein, we present a 15-year-old girl whose initial symptom was abdominal pain for three days and her pathological sign was a large abdominal mass which was verified by imaging studies and diagnosed as myeloid sarcoma by biopsy. On bone marrow examination, she had diagnosis of AML-M2 and by cytogenetic analysis inversion 16 was positive. She was treated with AML-BFM 2004 protocol and she is being followed up in remission on her ninth month of the maintenance therapy. Mustafa Çakan, Ahmet Koç, Kıvılcım Cerit, Süheyla Bozkurt, Rabia Ergelen, and Irmak Vural Copyright © 2014 Mustafa Çakan et al. All rights reserved. Management of Large Erupting Complex Odontoma in Maxilla Sun, 14 Dec 2014 09:47:13 +0000 We present the unusual case of a large complex odontoma erupting in the maxilla. Odontomas are benign developmental tumours of odontogenic origin. They are characterized by slow growth and nonaggressive behaviour. Complex odontomas, which erupt, are rare. They are usually asymptomatic and are identified on routine radiograph but may present with erosion into the oral cavity with subsequent cellulitis and facial asymmetry. This present paper describes the presentation and management of an erupting complex odontoma, occupying the maxillary sinus with extension to the infraorbital rim. We also discuss various surgical approaches used to access this anatomic area. Colm Murphy, John Edward O’Connell, Edward Cotter, and Gerard Kearns Copyright © 2014 Colm Murphy et al. All rights reserved. Symptomatic Floor-of-Mouth Swelling with Neck Extension in a 14-Year-Old Girl Wed, 03 Dec 2014 12:58:41 +0000 A plunging ranula is a soft-tissue mass stemming from a mucous extravasation cyst of the sublingual gland which can herniate through the mylohyoid muscle. We describe a case in which a 14-year-old girl presented with a rapidly expanding mass on the floor of her mouth affecting her ability to swallow and speak and causing tracheal compression. The patient was initially managed conservatively with antibiotics and steroids; however, the mass continued to expand necessitating emergent bedside incision and drainage and subsequent surgical intervention. The pathophysiology and management options for ranulas are also discussed herein. Kristin Dayton and Matthew F. Ryan Copyright © 2014 Kristin Dayton and Matthew F. Ryan. All rights reserved.