Introduction. Acute disseminated encephalomyelitis is a rare inflammatory demyelinating disease characterized by acute onset polyfocal neurological deficits associated with encephalopathy. It commonly presents with fever, meningism, seizures, ataxia, motor deficits, and bladder dysfunction. Although cranial neuropathies, including optic neuritis and facial nerve palsies, have previously been reported, children presenting with bilateral ptosis is extremely rare. Here, we report a 3-year-old child with acute disseminated encephalomyelitis presenting with acute onset bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. Case Presentation. A 3-year-old Sri Lankan boy presented with drooping of the upper eyelids for three days and unsteady gait for two days. He did not have seizures, blurring of vision, limb weakness, swallowing or breathing difficulties, or bladder dysfunction. On examination, he had bilateral ptosis, gait ataxia, and dysmetria. His vision, eye movements, and examination of other cranial nerves were normal. MRI brain revealed high signal intensities involving the subcortical white matter of parietal and occipital lobes, midbrain in the area of single central levator subnucleus of the oculomotor nerve, cerebellar vermis, and right cerebellar hemisphere. Based on the clinical features suggesting polyfocal neurological involvement of the midbrain and cerebellum and characteristic MRI findings, the diagnosis of acute disseminated encephalomyelitis was made. He responded well and rapidly to high-dose intravenous methylprednisolone and showed a complete clinical and radiological recovery. Conclusion. This case report describes a rare presentation of acute disseminated encephalomyelitis, bilateral ptosis due to involvement of the single central levator subnucleus of the oculomotor nerve. It highlights that the presenting manifestations of acute disseminated encephalomyelitis can be subtle and vary; however, timely diagnosis and treatment result in complete recovery.

Ishara Kumarasiri

Ruwan Samararathna

Udara Sandakelum

Oshanie Muthukumarana

Reha Balasubramaniam

Sachith Mettananda

Acute Disseminated Encephalomyelitis Presenting as Bilateral Ptosis in a Sri Lankan Child

Appendicitis is the most common cause for abdominal surgery in children. It is usually caused by Escherichia coli and Streptococcus species and is generally polymicrobial. However, Streptococcus pneumoniae is a rare cause of appendicitis. We report a rare case of pneumococcal appendicitis in a 7-year-old child with no underlying conditions, in association with E. coli and group F &#x3b2;-hemolytic Streptococcus. The isolated pneumococcal strain was sensible to all tested antibiotics. The patient had a full recovery after surgery and antibiotics. This case emphasizes that S. pneumoniae can cause a variety of unusual infections like appendicitis, in patients with or without underlying conditions. Thus, even though being a rare entity, physicians should always be aware of S. pneumoniae as a possible causative agent.

Amar Chikhaoui

N&#xe9;h&#xe9;mie Nzoyikorera

Mehdi El Mouadden

Mounia Al Zemmouri

Khalid Zerouali

A Rare Case of Pneumococcal Appendicitis in a Child

Multisystem inflammatory syndrome in children (MIS-C) after COVID-19 has been recognized as a complication arising due to cytokine storm. Several management strategies including intravenous immunoglobulin and immunomodulators have been reported. This case report highlights the use of a cytokine filter (oXiris&#xae;) in the management of MIS-C. Cytokine filters eliminate cytokines and reduce the demand for vasopressors in patients with other inflammatory conditions. A 7-year-old child with prolonged fever, vomiting, hypotension, elevated inflammatory mediators, and dilatation of coronary arteries on echocardiography was found to have positive SARS-CoV-2 IgG and PCR. He was diagnosed as MIS-C and was managed in the pediatric intensive care unit. He required ventilatory support, vasopressors, and continuous renal replacement therapy (CRRT) with a cytokine filter. He showed marked improvement within 24&#x2009;hours of initiating CRRT. Cytokine filters may have a potential role in the management of severely ill children due to MIS-C. To our knowledge, this is the first report of successful use of the oXiris&#xae; membrane in MIS-C. However, further case series and controlled trials are needed to establish its use in this condition.

Priyanka Lalwani

Subashini Baskaran

Diego Arango Uribe

Anil Ramaiah

Aqdas Saqib

Mohammed ElMesserey

Emad M. Fathi

Yuichi Tabata

Christoph Fink

Marco Pallavidino

A Case of COVID-19-Associated Pediatric Multisystem Inflammatory Syndrome in Shock Managed by Cytokine Filtration

Human parvovirus B19 (PVB19) infection causes neurological manifestations, including encephalitis, meningitis, and neuropathy, but facial nerve palsy is rare. Moreover, no case of facial nerve palsy related to PVB19 infection that was diagnosed by PCR and serology has been reported. A 19-month-old boy without the medical history developed facial nerve palsy and was treated with prednisolone and valacyclovir. On the 19th day, erythema appeared on his body, and the PVB19-specific IgM and PVB19 DNA were detected in the serum, leading to the diagnosis of infectious erythema associated with PVB19 infection. This case indicates that PVB19 may be one of the causative agents of facial nerve palsy.

Taro Fukuta

Yoshihiko Kawano

Maiko Ikeda

Jun-ichi Kawada

Yoshinori Ito

Shinya Hara

Diagnosis of Peripheral Facial Palsy Associated with Parvovirus B19 Infection by Polymerase Chain Reaction

Calcified amorphous tumor (CAT) of the heart is a rare nonneoplastic cardiac mass that may exhibit symptoms resembling malignancy. In this report, we presented a 4-month-old male baby with repeated attacks of cyanosis and a cardiac murmur. Echocardiography revealed a tumoral noncircumscribed mass in the right atrium adhering to the interatrial septum which extends to the inferior vena cava. Cardiac exploration was carried out to excise the tumor. A histopathological study demonstrated the presence of thrombus-like tissue with extensive calcification and foreign body type giant cell reactions. After operation, the patient had an uneventful hospitalization. Although CAT is mainly diagnosed in adult patients, it should be considered in the causes of cardiac mass in the neonatal period.

Mohammad Nasir Hematian

Kamran Hessami

Maasoumeh Saleh

Abolfazl Shirdel Abdolmaleki

Shirin Torabi

Sedigheh Hantoushzadeh

Cardiac Calcified Amorphous Tumor in the Neonatal Period

Leydig cell tumors, most often benign, are a rare cause of isosexual gonadotropin-independent precocious puberty in boys due to secretion of testosterone. Very rarely do these tumors produce estrogen, causing gynecomastia. Testicular sparing surgery is the mainstay of treatment currently although radical orchidectomy was the choice in the past. Following surgery, clinical signs improve along with a revision of biochemical changes. Occasionally, it has been reported few children are progressed to gonadotropin-dependent precocious puberty (GDPP) after initial clinical and biochemical recovery. Gonadotropin receptor analogs have been successful on them to halt the progression of puberty, and growth hormone administration has been used to optimize the adult height. Here, we report a case of a 10-year-old boy who presented very late due to failure in recognition of features of puberty due to a Leydig cell tumor. Even though he underwent successful radical orchidectomy, just within 1 month following surgery, he entered GDPP in contrast to the published cases where it was earliest detected at 3 months.

C. R. Naotunna

D. N. Siriwardana

B. C. Lakmini

M. Samarasinghe

N. Atapattu

A Matter of Time: Delayed Presentation and Rapid Progression from Gonadotropin-Independent to Gonadotropin-Dependent Precocious Puberty following Successful Treatment for a Leydig Cell Tumor

About this journal

Case Reports in Pediatrics publishes case reports and case series related to pediatric subspecialities such as adolescent medicine, cardiology, critical care, dentistry, developmental and behavioral medicine, endocrinology, gastroenterology etc.

Journal profile

Meet the editorial board

Case Reports in Pediatrics maintains an Editorial Board of practicing researchers from around the world, to ensure manuscripts are handled by editors who are experts in the field of study.

Editor spotlight

Find out more

This journal's articles appear in a wide range of abstracting and indexing databases, and are covered by numerous other services that aid discovery and access. Find out more about where and how the content of this journal is available.

Abstracting and Indexing

Author guidelines

Editorial board

Databases and indexing

Case Reports in Pediatrics - Table of contents 2022

title

Case Reports in Pediatrics publishes case reports and case series related to pediatric subspecialities such as adolescent medicine, cardiology, critical care, dentistry, developmental and behavioral medicine, endocrinology, gastroenterology etc.

Case Reports in Pediatrics