Case Reports in Pediatrics The latest articles from Hindawi Publishing Corporation © 2015 , Hindawi Publishing Corporation . All rights reserved. Giant Ovarian Cyst Masquerading as Massive Ascites in an 11-Year-Old Sun, 05 Jul 2015 10:05:35 +0000 We are presenting a unique case of an 11-year-old girl admitted for investigation of progressive abdominal distention of more than one-year duration. Due to the complete cystic nature of the mass and its enormous size, it was not visualized by the ultrasound and was reported as massive ascites. MRI and postoperative histopathology confirmed a diagnosis of giant serous cystadenoma of the right ovary. She underwent a right ovarian cystectomy with complete preservation of both ovaries and fallopian tubes and is doing well on outpatient follow-up. Shaza Ali Mohammed Elhassan, Shabina Khan, and Ahmed El-Makki Copyright © 2015 Shaza Ali Mohammed Elhassan et al. All rights reserved. Netherton Syndrome in a Neonate with Possible Growth Hormone Deficiency and Transient Hyperaldosteronism Wed, 01 Jul 2015 11:50:33 +0000 Netherton syndrome, a rare autosomal recessive genetic disorder, is classified as an ichthyosiform syndrome. In this report we present the case of a neonate with erythroderma shortly after birth, accompanied by severe hypernatremia, recurrent infections, transient hyperaldosteronism, and signs of growth hormone (GH) deficiency. DNA molecular analysis in the SPINK5 gene revealed heterozygosity in our index patient for 238insG and 2468delA frameshift mutations in exons 4 and 26, respectively, in the maternal allele and 1431-12G>A splice-site mutation in intron 15 in the paternal allele as well as the missense variation E420K in homozygous state. Combination of the identified mutations along with transient hyperaldosteronism and possible GH deficiency have not been described before. Accordingly, the importance of early multidisciplinary approach is highlighted, in order to reach accurate diagnosis, initiate prompt treatment, and ensure survival with fewer disease complications. Chatziioannidis Ilias, Babatseva Evgenia, Patsatsi Aikaterini, Galli-Tsinopoulou Asimina, Sarri Constantina, Lithoxopoulou Maria, Mitsiakos George, Karagianni Paraskevi, Tsakalidis Christos, Mamuris Zissis, and Nikolaidis Nikolaos Copyright © 2015 Chatziioannidis Ilias et al. All rights reserved. Cardiac Arrest following a Myocardial Infarction in a Child Treated with Methylphenidate Sun, 28 Jun 2015 07:15:26 +0000 The use of psychostimulants labeled to treat attention deficit/hyperactivity disorder increases. Among side effects these drugs raise blood pressure and heart rate, and the safety has been scrutinised in recent years. Data from large epidemiological studies, including over a million person-years, did not report any cases of myocardial infarction in current users of methylphenidate, and the risk of serious adverse cardiac events was not found to be increased. We present a case with an 11-year-old child, treated with methylphenidate, who suffered cardiac arrest and was diagnosed with a remote myocardial infarction. This demonstrates that myocardial infarction can happen due to methylphenidate exposure in a cardiac healthy child, without cardiovascular risk factors. Kim Munk, Lise Gormsen, Won Yong Kim, and Niels Holmark Andersen Copyright © 2015 Kim Munk et al. All rights reserved. 17-Year-Old Boy with Renal Failure and the Highest Reported Creatinine in Pediatric Literature Sun, 14 Jun 2015 09:44:47 +0000 The prevalence of chronic kidney disease (CKD) is on the rise and constitutes a major health burden across the world. Clinical presentations in early CKD are usually subtle. Awareness of the risk factors for CKD is important for early diagnosis and treatment to slow the progression of disease. We present a case report of a 17-year-old African American male who presented in a life threatening hypertensive emergency with renal failure and the highest reported serum creatinine in a pediatric patient. A brief discussion on CKD criteria, complications, and potential red flags for screening strategies is provided. Vimal Master Sankar Raj, Jessica Garcia, and Roberto Gordillo Copyright © 2015 Vimal Master Sankar Raj et al. All rights reserved. The Combination of Gastroschisis, Jejunal Atresia, and Colonic Atresia in a Newborn Tue, 09 Jun 2015 16:06:37 +0000 We encountered a rare case of gastroschisis associated with jejunal atresia and colonic atresia. In our case, the jejunal atresia was not discovered for 27 days after the initial abdominal wall closure. The colonic atresia was not discovered for 48 days after initial repair of the gastroschisis secondary to the rarity of the disorder. Both types of atresia were repaired with primary hand-sewn anastomoses. Other than the prolonged parenteral nutrition and hyperbilirubinemia, our patient did very well throughout his hospital course. Based on our case presentation, small bowel atresia and colonic atresia must be considered in patients who undergo abdominal wall closure for gastroschisis with prolonged symptoms suggestive of bowel obstruction. Our case report also demonstrates primary enteric anastomosis as a safe, well-tolerated surgical option for patients with types of intestinal atresia. Zachary Bauman and Victor Nanagas Jr. Copyright © 2015 Zachary Bauman and Victor Nanagas Jr. All rights reserved. Massive Gastric Hemorrhage due to Dieulafoy’s Lesion in a Preterm Neonate: A Case Report and Literature Review of the Lesion in Neonates Mon, 08 Jun 2015 08:14:51 +0000 Dieulafoy’s lesion is an extremely rare cause of upper gastrointestinal bleeding in the neonatal age group. Till now, only 6 cases of Dieulafoy’s lesion in neonatal period have been reported in the international literature. Herein, we report an extremely rare case of Dieulafoy’s lesion in a preterm neonate. Christos Salakos, Panayiota Kafritsa, Yvelise de Verney, Ariadni Sageorgi, and Nick Zavras Copyright © 2015 Christos Salakos et al. All rights reserved. 45,X/47,XXX Mosaicism and Short Stature Sun, 07 Jun 2015 09:02:51 +0000 We describe the case of a ten-year-old girl with short stature and 45,X/47,XXX genotype. She also suffered from vesicoureteric reflux and kidney dysfunction prior to having surgery on her ureters. Otherwise, she does not have any of the characteristics of Turner nor Triple X syndrome. It has been shown that this mosaic condition as well as other varieties creates a milder phenotype than typical Turner syndrome, which is what we mostly see in our patient. However, this patient is a special case, because she is exceptionally short. Overall, one cannot predict the resultant phenotype in these mosaic conditions. This creates difficulty in counseling parents whose children or fetuses have these karyotypes. Erica Everest, Laurie A. Tsilianidis, Anzar Haider, Douglas G. Rogers, Nouhad Raissouni, and Bahareh Schweiger Copyright © 2015 Erica Everest et al. All rights reserved. Successful Treatment of Candida parapsilosis Fungemia in Two Preterms with Voriconazole Thu, 04 Jun 2015 08:23:07 +0000 Herein, we report two preterms with invasive candidiasis refractory to liposomal amphotericin B (AMB) treatment in spite of low MIC levels (MIC: 0.5 mcg/mL). Both of the patients’ blood cultures were persistently positive for C. parapsilosis despite high therapeutic doses (AMB: 7 mg/kg per day). After starting voriconazole blood cultures became negative and both of the patients were treated successfully without any side effects. In conclusion, although it is not a standard treatment in neonatal patients, our limited experience with these patients suggests that voriconazole appears to be a safe antifungal agent to be used in critically ill preterm infants with persistent fungemia despite AMB treatment. Emel Altuncu, Hulya Bilgen, Ahmet Soysal, and Eren Ozek Copyright © 2015 Emel Altuncu et al. All rights reserved. Short Stature in Chronic Kidney Disease Treated with Growth Hormone and an Aromatase Inhibitor Mon, 25 May 2015 13:51:55 +0000 We describe an alternative strategy for management of severe growth failure in a 14-year-old child who presented with advanced chronic kidney disease close to puberty. The patient was initially treated with growth hormone for a year until kidney transplantation, followed immediately by a year-long course of an aromatase inhibitor, anastrozole, to prevent epiphyseal fusion and prolong the period of linear growth. Outcome was excellent, with successful transplant and anticipated complete correction of height deficit. This strategy may be appropriate for children with chronic kidney disease and short stature who are in puberty. Susan R. Mendley, Fotios Spyropoulos, and Debra R. Counts Copyright © 2015 Susan R. Mendley et al. All rights reserved. Postinjection Muscle Fibrosis from Lupron Mon, 25 May 2015 06:55:25 +0000 We describe the case of a 6.5-year-old girl with central precocious puberty (CPP), which signifies the onset of secondary sexual characteristics before the age of eight in females and the age of nine in males as a result of stimulation of the hypothalamic-pituitary-gonadal axis. Her case is likely related to her adoption, as children who are adopted internationally have much higher rates of CPP. She had left breast development at Tanner Stage 2, adult body odor, and mildly advanced bone age. In order to halt puberty and maximize adult height, she was prescribed a gonadotropin releasing hormone analog, the first line treatment for CPP. She was administered Lupron (leuprolide acetate) Depot-Ped (3 months) intramuscularly. After her second injection, she developed swelling and muscle pain at the injection site on her right thigh. She also reported an impaired ability to walk. She was diagnosed with muscle fibrosis. This is the first reported case of muscle fibrosis resulting from Lupron injection. Erica Everest, Laurie A. Tsilianidis, Nouhad Raissouni, Tracy Ballock, Terra Blatnik, Anzar Haider, Douglas G. Rogers, and B. Michelle Schweiger Copyright © 2015 Erica Everest et al. All rights reserved. Orthosis Effects on the Gait of a Child with Infantile Tibia Vara Thu, 21 May 2015 16:03:26 +0000 Infantile tibia vara (ITV) is an acquired form of tibial deformity associated with tibial varus and internal torsion. As there is currently insufficient data available on the effects of orthotics on gait parameters, this study aimed to document the influence of orthosis on walking. A male infant with bilateral tibia vara used orthoses for five months. Gait evaluations were performed pre- and posttreatment for both legs. The kinematic parameters were collected by using a motion analysis system. The orthotic design principle was used to correct the femur and tibia. Posttreatment gait parameters were improved compared to pretreatment parameters. After 5 months, there was remarkable change in the stance-phase degrees of frontal plane hip joint abduction and knee joint varus. We found that orthoses were an effective treatment for the infantile tibia vara gait characteristics in this patient. Full-time use of single, upright knee-ankle-foot orthosis with a drop lock knee joint and application of corrective forces at five points along the full length of the limb were effective. Serap Alsancak and Senem Guner Copyright © 2015 Serap Alsancak and Senem Guner. All rights reserved. Clinical and Imaging Features of a Congenital Midline Cervical Cleft in a Neonate: A Rare Anomaly Thu, 21 May 2015 13:01:48 +0000 Congenital midline cervical cleft (CMCC) is a rare congenital anomaly. CMCC and its complications and treatment have been well described in ENT, dermatology, and pediatric surgery literature. However, to our knowledge, the imaging work-up has not been reported in the literature thus far. We present a case of CMCC in a neonate with description of clinical presentation and imaging features. Rachelle Goldfisher, Pritish Bawa, Zachary Ibrahim, and John Amodio Copyright © 2015 Rachelle Goldfisher et al. All rights reserved. Chronic Lipoid Pneumonia in a 9-Year-Old Child Revealed by Recurrent Chest Pain Thu, 21 May 2015 11:56:18 +0000 Lipoid pneumonia in children is a rare disorder due to accumulation of fatty oily material in the alveoli and usually associated with an underlying condition. In absence of obvious context, diagnosis remains difficult with nonspecific clinical and radiological features. We report the first case of voluntary chronic aspiration of olive oil responsible for exogenous lipoid pneumonia, in a previously healthy 9-year-old boy. Clinical presentation was atypical; LP was revealed by isolated chest pain. We discuss radiological and bronchial alveolar lavage characteristics suggestive of lipoid pneumonia. Conclusion. Lipoid pneumonia is a disease to be reminded of in children, which can occur with original findings in terms of etiology and clinical presentation. A. Hochart, C. Thumerelle, L. Petyt, C. Mordacq, and A. Deschildre Copyright © 2015 A. Hochart et al. All rights reserved. Rahnella aquatilis Sepsis in a Premature Newborn Mon, 18 May 2015 09:38:31 +0000 Rahnella aquatilis is an infrequently isolated Gram-negative rod within the Enterobacteriaceae family. The organism’s natural habitat is water. The organism is rarely isolated from clinical specimens and it seldom causes infection in immunocompetent individuals. Here we present a one-month-old boy who was born prematurely at 27th week of gestation by cesarean section with a birth weight of 730 g. He developed sepsis caused by Rahnella aquatilis during the treatment for ventilator associated pneumonia due to Stenotrophomonas maltophilia with ciprofloxacin. He was successfully treated with a combination of amikacin plus meropenem. Although R. aquatilis is one of the saprophyticus organisms, it may cause life-threatening infection in newborn. Canan Kuzdan, Ahmet Soysal, Hülya Özdemir, Şenay Coşkun, İpek Akman, Hülya Bilgen, Eren Özek, and Mustafa Bakır Copyright © 2015 Canan Kuzdan et al. All rights reserved. Molar Tooth Sign with Deranged Liver Function Tests: An Indian Case with COACH Syndrome Sun, 17 May 2015 09:51:51 +0000 We report the first genetically proven case of COACH syndrome from the Indian subcontinent in a 6-year-old girl who presented with typical features of Joubert syndrome along with hepatic involvement. Mutation analysis revealed compound heterozygous missense mutation in the known gene TMEM67 (also called MKS3). Rama Krishna Sanjeev, Seema Kapoor, Manisha Goyal, Rajiv Kapur, and Joseph Gerard Gleeson Copyright © 2015 Rama Krishna Sanjeev et al. All rights reserved. Acute Kidney Injury Complicated Epstein-Barr Virus Infection in Infancy Mon, 04 May 2015 13:14:32 +0000 Infectious mononucleosis is an acute lymphoproliferative disorder caused by the Epstein-Barr virus (EBV) and seen most commonly in children and young adults. Clinical presentation of the disease is characterized by fever, tonsillopharyngitis, lymphadenopathy, and hepatosplenomegaly, whereas serological findings of this benign disorder include positive heterophilic antibody formation (transient increase in heterophilic antibodies) and prominence of hematological lymphocytosis of more than 10% of atypical lymphocytes. An EBV infection is usually asymptomatic in childhood, but acute kidney injury can be a rare complication during its course. Most cases recover from the disease completely. Early recognition of EBV infection and estimation of its complication are important for its prognosis. In light of previous literature, we discuss the case evaluated as an EBV infection complicated by acute kidney injury in early childhood and results of tubulointerstitial nephritis shown on a renal biopsy that was later diagnosed as an EBV infection by serological examination. Gamze Ozgurhan, Mustafa Ozcetin, Aysel Vehapoglu, Zeynep Karakaya, and Fatih Aygun Copyright © 2015 Gamze Ozgurhan et al. All rights reserved. Hyperinsulinemic Hypoglycaemia in a Turner Syndrome with Ring (X) Wed, 29 Apr 2015 11:29:11 +0000 Hyperinsulinemic hypoglycaemia (HH) is a group of clinically, genetically, and morphologically heterogeneous disorders characterized by dysregulation of insulin secretion by pancreatic beta cells. HH can either be congenital genetic hyperinsulinism or associated with metabolic disorder and syndromic condition. Early identification and meticulous management of these patients is vital to prevent neurological insult. There are only three reported cases of HH associated with a mosaic, r(X) Turner syndrome. We report the four cases of an infant with a mosaic r(X) Turner genotype and HH responsive to diazoxide therapy. Michela Cappella, Vanna Graziani, Antonella Pragliola, Alberto Sensi, Khalid Hussain, Claudia Muratori, and Federico Marchetti Copyright © 2015 Michela Cappella et al. All rights reserved. NIV-Helmet in Severe Hypoxemic Acute Respiratory Failure Mon, 27 Apr 2015 13:35:50 +0000 Noninvasive ventilation (NIV) is a method to be applied in acute respiratory failure, given the possibility of avoiding tracheal intubation and conventional ventilation. A previous healthy 5-month-old boy developed low-grade intermittent fever, flu-like symptoms, and dry cough for 3 days. On admission, he showed severe respiratory distress with SpO2/FiO2 ratio of 94. Subsequent evaluation identified an RSV infection complicated with an increase of inflammatory parameters (reactive C protein 15 mg/dL). Within the first hour after NIV-helmet CPAP SpO2/FiO2 ratio increased to 157. This sustained improvement allowed the continuing of this strategy. After 102 h, he was disconnected from the helmet CPAP device. The NIV use in severe hypoxemic acute respiratory failure should be carefully monitored as the absence of clinical improvement has a predictive value in the need to resume to intubation and mechanical ventilation. We emphasize that SpO2/FiO2 ratio is a valuable monitoring instrument. Helmet interface use represents a more comfortable alternative for providing ventilatory support, particularly to small infants, which constitute a sensitive group within pediatric patients. Joana Martins, P. Nunes, C. Silvestre, C. Abadesso, H. Loureiro, and H. Almeida Copyright © 2015 Joana Martins et al. All rights reserved. Two Mutations in Surfactant Protein C Gene Associated with Neonatal Respiratory Distress Mon, 27 Apr 2015 13:04:59 +0000 Multiple mutations of surfactant genes causing surfactant dysfunction have been described. Surfactant protein C (SP-C) deficiency is associated with variable clinical manifestations ranging from neonatal respiratory distress syndrome to lethal lung disease. We present an extremely low birth weight male infant with an unusual course of respiratory distress syndrome associated with two mutations in the SFTPC gene: C43-7G>A and 12T>A. He required mechanical ventilation for 26 days and was treated with 5 subsequent doses of surfactant with temporary and short-term efficacy. He was discharged at 37 weeks of postconceptional age without any respiratory support. During the first 16 months of life he developed five respiratory infections that did not require hospitalization. Conclusion. This mild course in our patient with two mutations is peculiar because the outcome in patients with a single SFTPC mutation is usually poor. Anna Tarocco, Elisa Ballardini, Maria Raffaella Contiero, Giampaolo Garani, and Silvia Fanaro Copyright © 2015 Anna Tarocco et al. 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.