Case Reports in Pediatrics https://www.hindawi.com The latest articles from Hindawi © 2017 , Hindawi Limited . All rights reserved. A Giant Cavernous Hemangioma of the Left Atrioventricular Groove Mon, 20 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/6898629/ A 10-year-old Chinese female diagnosed with an asymptomatic giant cardiac cavernous hemangioma was reported. The patient originally tended to observation because this unusual cardiac tumoral mass was discovered incidentally during routine health examination of transthoracic echocardiography. Over 5 years of follow-up, the mass had enlarged obviously, and the patient visited our outpatient clinic and was prone to excision. Subsequently, a total resection surgery of the tumor was performed, and the tumor was found to be located on the left atrioventricular groove with complete packing membrane. The patient was discharged on postoperative day 4 and remains asymptomatic on last follow-up. Chengming Fan, Changming Tan, Demiao Kong, Jinfu Yang, Shuwen Yuan, and Sijie Wu Copyright © 2017 Chengming Fan et al. All rights reserved. Persistent Oxygen Requirement beyond Prematurity: A Case of Acquired Pulmonary Vein Stenosis Tue, 14 Mar 2017 10:02:11 +0000 http://www.hindawi.com/journals/cripe/2017/3106871/ Acquired pulmonary vein stenosis is a rare cardiac defect and diagnosis can often be challenging, as many cases present with refractory or prolonged oxygen requirement over the expected course. Comorbid conditions can cloud this diagnosis further. Prognosis is poor for most patients. We present a case of idiopathic acquired pulmonary vein stenosis and discuss diagnostics, treatment options, and the need for further collaborative studies. Tyler A. Fick, Bernadette Richards, Carl H. Backes, and Molly K. Ball Copyright © 2017 Tyler A. Fick et al. All rights reserved. Coarctation of the Aorta as a Complication of Surgical Ligation of Patent Ductus Arteriosus in a Premature Infant Mon, 13 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/2647353/ Surgical ligation of a patent ductus arteriosus (PDA) is a commonly performed procedure. Complications are infrequent and most commonly include recurrent laryngeal nerve injury and rarely ligation of left pulmonary artery. We report a case of accidental ligation of the descending thoracic aorta leading to a clinically significant coarctation. Amna Qasim, Soham Dasgupta, Sunil K. Jain, Amyn K. Jiwani, and Ashraf M. Aly Copyright © 2017 Amna Qasim et al. All rights reserved. Seronegative Coeliac Disease in Children: A Case Report and Review of the Literature Mon, 13 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/1652052/ Serology is frequently used for the diagnosis of coeliac disease in children; however, a small proportion of children are seronegative. We present a case of seronegative coeliac disease along with literature review to include diagnostic and management dilemmas. Vinod Kolimarala, Ekta Vasita, Hany Banoub, and Sonny K. F. Chong Copyright © 2017 Vinod Kolimarala et al. All rights reserved. Transumbilical Surgery for Duodenal Stenosis in a Child with Situs Inversus: The First Report Sun, 12 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/2074387/ Background. Situs inversus is a rare congenital anomaly with a reported incidence of only 1 in 5,000 to 10,000 live births. Congenital duodenal stenosis complicated with situs inversus is an even rarer entity. Case Presentation. A 1-year-old girl with situs inversus who had undergone a hemi-Fontan procedure against a single ventricle in our hospital was referred to our department for vomiting and failure to thrive. An upper gastrointestinal contrast study and endoscopy revealed duodenal stenosis. A transumbilical radical operation as a minimally invasive surgery was successfully performed. After the surgery, she stopped vomiting, and the postoperative course was uneventful with good cosmetic results. Conclusions. To our knowledge, this is the first report of transumbilical surgery for congenital duodenal stenosis with situs inversus as minimally invasive surgery. Transumbilical surgery to situs inversus patient can be performed safely and lead to good cosmetic outcome. Isamu Saeki, Yu Ueno, Wataru Mukai, Reisuke Imaji, and Takashi Akiyama Copyright © 2017 Isamu Saeki et al. All rights reserved. Pulmonary Arteriovenous Malformation Causing Systemic Hypoxemia in Early Infancy Wed, 08 Mar 2017 07:29:52 +0000 http://www.hindawi.com/journals/cripe/2017/2841720/ Pulmonary arteriovenous malformation (AVM) is not routinely appreciated during the standard echocardiogram to assess for structural abnormalities or pulmonary hypertension. The distal pulmonary AVM is suspected only if an injection of agitated saline is performed and late entry of particles is appreciated in the left heart structures. A large or complex pulmonary AVM can result in significant right-to-left shunting and consequential systemic hypoxemia in the presence or absence of pulmonary hypertension. For direct visualization of the pulmonary AVM, computerized tomography (CT) scan is the procedure of choice. Here, we present two young infants with systemic hypoxemia who underwent standard medical management including mechanical ventilation and one patient was placed on extracorporeal membrane oxygenation (ECMO) before the diagnosis of pulmonary AVM was established. Subsequently, both patients have done well into mid-term follow-up after being treated successfully using transcatheter occlusion techniques in the cardiac catheterization laboratory during early infancy. We aim to emphasize the importance of a high index of suspicion for pulmonary AVM in infants with refractory systemic hypoxemia of unclear etiology. V. Aggarwal, D. M. Khan, and J. F. Rhodes Copyright © 2017 V. Aggarwal et al. All rights reserved. Anti-K1 (Kell) Antibody Expressed in Maternal Breastmilk: A Case Report of a Neonate with Multiple Intrauterine Transfusions and Postnatal Exposure to Kell Antibody in Maternal Breastmilk Sun, 05 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/6927813/ Hemolytic disease of the fetus and newborn is a common consideration in newborn medicine, especially among the jaundiced. Maternal breastmilk provides numerous benefits to the infant, including nutrition and immunologic factors. Here, we present an infant who received three intrauterine transfusions for anemia secondary to anti-K1 (Kell), anti-C, and anti-e antibodies and whose maternal breastmilk tested positive for anti-Kell antibodies. The infant required another transfusion at 4 weeks of life for anemia. We review the pathophysiology of anti-Kell antibodies, the immunology of breast milk, and the intersection of these two topics. Patrick DeMoss, Mohamed Asfour, and Kelly Hersey Copyright © 2017 Patrick DeMoss et al. All rights reserved. A Wandering Abdominal Mass in a Neonate: An Enteric Duplication Cyst Mimicking an Ovarian Cyst Thu, 02 Mar 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/9209126/ Enteric duplication cysts are rare congenital anomalies that are prenatally diagnosed through antenatal ultrasonography (US). In female patients, however, attention must be paid since these formations might be confused with ovarian cysts. Herein, we present a case of a low birth weight female infant with an enteric duplication cyst. A cystic lesion was detected in the right abdomen of the fetus on antenatal US and magnetic resonance imaging (MRI). Serial US and MRI examinations performed after birth showed a single cyst that wandered from side to side in the abdomen; the initial diagnosis was thought to be an ovarian cyst. During laparotomy, however, it was found to be an enteric duplication cyst with volvulus. To our knowledge, there has been no report of an enteric duplication cyst presenting as a wandering abdominal mass. Our experience indicates that early intervention is necessary for patients who have a wandering abdominal mass to avoid complications and urgent surgery, whether it is an ovarian cyst or an enteric duplication cyst. Shigeo Iijima Copyright © 2017 Shigeo Iijima. All rights reserved. Gastric Duplication: A Rare Cause of Recurrent Vomiting Wed, 01 Mar 2017 10:02:19 +0000 http://www.hindawi.com/journals/cripe/2017/2348274/ Vomiting is a physical finding that can occur at any age but presents the greatest challenge when it is recurrent in a child. The etiology is varied (Sieunarine and Manmohansingh, 1989; Suzuki, 1982), and recurrent vomiting can be a symptom of life threatening medical or surgical emergencies. Early recognition is mandatory for preventing delay in management and potential complications. Gastric duplication is rare and mostly diagnosed in infancy with only a few cases documented in the medical literature presenting in childhood. We present a three-year-old Vietnamese female with recurrent vomiting. Obstruction and sepsis were ruled out as a cause of the recurrent vomiting by history and appropriate tests. Persistent vomiting and paucity of air on the plain abdominal films provided a clue to the diagnosis. A CT scan of the abdomen with contrast revealed a uniformly thin walled fluid attenuation mass in the epigastric region which did not opacify with contrast. An abdominal ultrasound confirmed gastric duplication cyst and the patient was taken to the operating room for excision of the cyst. Brahmananda Koduri, Katie McHale, Christina Yost, Michael H. Goodman, and Dennis Hoelzer Copyright © 2017 Brahmananda Koduri et al. All rights reserved. Osteonecrosis of the Femoral Head in an Adolescent on Long-Term Inhalational Corticosteroids Tue, 28 Feb 2017 11:12:33 +0000 http://www.hindawi.com/journals/cripe/2017/6969787/ A relationship between the development of osteonecrosis of the femoral head and systemic corticosteroids has been well established in the literature, particularly in adults. However, the link between osteonecrosis and inhaled corticosteroids is less researched and understood. We report an usual case report of a 10-year-old male who developed ipsilateral femoral head osteonecrosis after long-term inhalational corticosteroid and intermittent short courses of oral steroid usage with a unique presentation and delayed diagnosis. Anthony C. Egger and R. Tracy Ballock Copyright © 2017 Anthony C. Egger and R. Tracy Ballock. All rights reserved. Cervical Stimulation in the Treatment of Children with Lymphedema of All Four Extremities: A Case Report and Literature Review Tue, 28 Feb 2017 08:44:37 +0000 http://www.hindawi.com/journals/cripe/2017/9724524/ Aim. The aim of this study is to report on the use of cervical stimulation as monotherapy to reduce swelling and normalize the size of limbs in two children with lymphedema of all four extremities. Case Presentation. One child also had hemifacial edema. In both cases, the mothers were trained to perform cervical stimulation under professional supervision. The cases of two girls, one of eight months and the other of six months, with primary congenital lymphedema are described. Outcome. After clinical diagnosis, the patients started treatment with cervical stimulation three times per week. The mothers were trained in cervical stimulation and, when the therapy team was confident about the mothers’ ability to perform the technique, the children began to be treated at home. The Godoy & Godoy cervical stimulation technique consists of around 20 to 30 light stroking movements per minute in the cervical region which stimulate the lymphatics. Perimetric measurements were made of the feet, legs, and the hands. Only two points (3 and 6 cm) along the dorsum of the feet and hands and points at 5 cm intervals up the legs starting at the ankle were considered. Today, the children are 5 and 6 years of age, without edema and with a normal life, without limitations, except with respect to precautions against injuries to the limbs and against infections particularly erysipelas. Conclusion. Cervical Lymphatic Therapy as monotherapy is an option in the treatment of primary congenital lymphedema. Livia Maria Pereira de Godoy, Paula Pereira de Godoy Capeletto, José Maria Pereira de Godoy, and Maria de Fátima Guerreiro Godoy Copyright © 2017 Livia Maria Pereira de Godoy et al. All rights reserved. Propylene Glycol Toxicity in Adolescent with Refractory Myoclonic Status Epilepticus Sun, 26 Feb 2017 08:03:23 +0000 http://www.hindawi.com/journals/cripe/2017/2979486/ Propylene glycol (PG) is a solvent commonly used in medications that, while benign at low doses, may cause toxicity in adults and children at high doses. We describe a case and the physiologic sequelae of propylene glycol toxicity manifested in a critically ill adolescent male with refractory myoclonic status epilepticus aggressively treated with multiple PG-containing medications (lorazepam, phenobarbital, and pentobarbital)—all within accepted dosing guidelines and a total daily PG exposure previously recognized to be safe. Hemodynamic measurements by bedside echocardiography during clinical toxicity are also reported. Clinicians should have a high index of suspicion for propylene glycol toxicity in patients treated with PG-containing medications even when the total PG exposure is lower than currently accepted limits. Kara A. Bjur, Bryan C. Cannon, Anthony L. Fine, Matthew J. Ritter, Kerry E. Schueler, and Michael E. Nemergut Copyright © 2017 Kara A. Bjur et al. All rights reserved. Facial Asymmetry in a Crying Newborn: A Comparison of Two Cases and Review of Literature Sun, 26 Feb 2017 07:16:14 +0000 http://www.hindawi.com/journals/cripe/2017/6368239/ Facial asymmetry in a crying newborn can be due to a variety of different causes. Neonatal asymmetric crying facies (NACF) is a specific phenotype, which is often underrecognized. It is defined as asymmetry of the mouth and lips with grimacing or smiling, but a symmetric appearance at rest. NACF needs to be differentiated from complete facial palsy in a newborn, which can occur due to traumatic or developmental etiologies. Developmental causes can be present in isolation or may be a part of a recognized syndrome. While asymmetric lower lip depression may be seen in both conditions, complete facial palsy is also associated with upper and mid face deformities. We present a case of NACF and compare it to a case of facial palsy due to perinatal trauma. The purpose of this case series is to clarify some of the confusing nomenclatures and highlight the differences in the physical exam findings, diagnosis, and eventual prognosis of these cases. Shreyas Arya, Sunil K. Jain, and Carol J. Richardson Copyright © 2017 Shreyas Arya et al. All rights reserved. A Rare Adrenal Mass in a 3-Month-Old: A Case Report and Literature Review Thu, 23 Feb 2017 09:15:44 +0000 http://www.hindawi.com/journals/cripe/2017/4542321/ A three-month-old female infant presented with abdominal distention for 2 months. A large palpable mass in right upper quadrant was noted on physical exam. Abdominal ultrasound revealed a large heterogeneous mass with multiple cystic components. Mass was surgically excised and pathology was consistent with mature adrenal teratoma. Teratoma is a germ cell tumor mainly found in gonadal tissues. Occurrence of adrenal gland teratoma in children is very rare with less than 10 pediatric case reports in English literature. We present a rare case of primary adrenal tumor in an infant and a review of the literature. Ashish Garg, Elza Pollak-Christian, and Navneetha Unnikrishnan Copyright © 2017 Ashish Garg et al. All rights reserved. A Marked Response to Immunosuppressive Intervention for Abruptly Occurring Cardiac Complications in a Case of Juvenile Systemic Sclerosis Overlapped with Dermatomyositis Tue, 21 Feb 2017 12:32:12 +0000 http://www.hindawi.com/journals/cripe/2017/1479012/ Juvenile-onset systemic sclerosis (jSSc) is a rare condition, having unique characteristic features compared to adult-onset SSc. Although cardiac involvement (CI) is known as a leading cause of mortality overall in SSc, the importance of CI in jSSc has not been emphasized. Here we present a 13-year-old female with jSSc overlapped with dermatomyositis (DM) complicated CI. She developed skin thickness and induration, Raynaud’s phenomenon, digital pitting scars in fingertips, and skeletal myositis. Oral prednisolone and pulse methotrexate treatment led to the improvement of skin findings; however two weeks after the initiation she suddenly presented with muscle pain and dyspnea within a few days. Cardiac investigations then showed pericardiac effusion and diastolic dysfunction due to significant biventricular hypertrophy causing heart failure. As pericardiac effusion and exacerbation of skeletal myositis were evident, steroid pulse therapy was initiated. Unexpectedly, not only the myositis but also the CI including diastolic dysfunction was improved. She thereafter followed a favorable clinical course without reactivation of the CI or cardiac fibrosis. As a conclusion, close attention to CI must be paid in jSSc patients, especially when skeletal muscle involvement is evident and immunosuppressive therapy may be effective for CI in jSSc in cases where it occurs abruptly. Tsunehisa Nagamori, Yoichiro Yoshida, Hironori Takahashi, Hideharu Oka, Aya Kajihama, Koichi Nakau, Masaya Sugimoto, Masako Minami-Hori, and Hiroshi Azuma Copyright © 2017 Tsunehisa Nagamori et al. All rights reserved. Central Nervous System Involvement in Henoch-Schonlein Purpura in Children and Adolescents Tue, 21 Feb 2017 07:46:06 +0000 http://www.hindawi.com/journals/cripe/2017/5483543/ Central nervous system (CNS) involvement in Henoch-Schonlein purpura (HSP) is rare but poses diagnostic difficulties. The aim of the study was to establish the frequency of CNS involvement in HSP, to analyze its clinical characteristics and do a literature review. Medical files of patients with HSP admitted at the Department of Pediatrics, Plovdiv, were studied retrospectively for a five-year period (2009–2013). Diagnosis was based on the American College of Rheumatology criteria. Out of 112 children with HSP 1 case (0.9%) had CNS involvement presenting as Posterior Reversible Encephalopathy Syndrome (PRES), which may be a result of CNS vasculitis or arterial hypertension. It was an 8-year-old girl with atypical HSP which started with abdominal pain requiring surgery. On the third day after the operation a transient macular rash and arterial hypertension appeared, followed by visual disturbances, hemiconvulsive epileptic seizures, postictal hemiparesis, and confusion. Head CT showed occipital hypodense lesions and MRT-T2 hyperintense lesion in the left occipital lobe. The patient experienced a second similar episode after 2 weeks when palpable purpura had also appeared. Neurological symptoms and MRI resolved completely. HSP can be an etiological factor for PRES in childhood. Although PRES is a rare complication of HSP, clinicians must be aware of it and avoid diagnostic and therapeutic delays. Iliyana H. Pacheva, Ivan S. Ivanov, Krastina Stefanova, Elena Chepisheva, Lyubov Chochkova, Dafina Grozeva, Angelina Stoyanova, Stojan Milenkov, Penka Stefanova, and Anna Petrova Copyright © 2017 Iliyana H. Pacheva et al. All rights reserved. A Rare Cause of Childhood Cerebellitis-Influenza Infection: A Case Report and Systematic Review of Literature Mon, 20 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/4039358/ Acute cerebellitis is a benign neurologic condition generally caused by viral or bacterial infections. Influenza associated cerebellitis is extremely rare; a 6-year-old boy with acute cerebellitis, who presented with fever, vomiting, weakness, febrile seizure, and acute cerebellar features, is discussed in this article. Şule Gökçe, Zafer Kurugol, and Aslı Aslan Copyright © 2017 Şule Gökçe et al. All rights reserved. Hematemesis as Initial Presentation in a 10-Week-Old Infant with Eosinophilic Gastroenteritis Thu, 16 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/2391417/ Eosinophilic gastroenteritis is a rare condition characterized by eosinophilic inflammation in the gastrointestinal tract resulting in a variety of gastrointestinal symptoms. There is currently a dearth of information on this topic in the pediatric literature, as very few cases have been reported. In this report, we present a case of eosinophilic gastroenteritis in a 10-week-old patient with initial presenting symptom of hematemesis. To our knowledge, this is the youngest case reported in the literature and is unique in its initial presentation. Varun Shetty, Kayla E. Daniel, and Anil Kesavan Copyright © 2017 Varun Shetty et al. All rights reserved. Complete Obstruction of Endotracheal Tube in an Infant with a Retropharyngeal and Anterior Mediastinal Abscess Tue, 14 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/1848945/ Intraoperative ventilatory failure is not an uncommon complication; however, acute endotracheal obstruction by a foreign body or blood clot can be difficult to quickly discriminate from other causes. Once the diagnosis is made, quick action is needed to restore ventilation. The ultimate solution is to exchange the endotracheal tube; however, there can be other ways of resolving this in situations where reintubation would be difficult or unsafe. This case report discusses such an event in an infant with multiple airway challenges including a retropharyngeal and anterior mediastinal abscess. We have also formulated a pathway based on various case reports involving complete ETT obstruction. Dennis B. Thapa, Nathaniel H. Greene, and Andrea G. Udani Copyright © 2017 Dennis B. Thapa et al. All rights reserved. Vitamin K Deficiency Presenting in an Infant with an Anterior Mediastinal Mass: A Case Report and Review of the Literature Thu, 09 Feb 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/7628946/ We report a case of a 1-month-old infant with spontaneous thymic hemorrhage secondary to severe vitamin K deficiency. He was brought to medical attention due to scrotal bruising and during evaluation was noted to be tachypneic and hypoxemic. Chest X-ray revealed an enlarged cardiothymic silhouette, and a follow-up echocardiogram revealed a mass in the anterior mediastinum. Routine laboratory work-up revealed severe coagulopathy. Further questioning revealed the patient had not received prophylactic vitamin K at birth. The coagulopathy resolved with administration of vitamin K, and a biopsy confirmed the anterior mediastinal mass was due to spontaneous thymic hemorrhage. Mauricio A. Palau, Amanda Winters, Xiayuan Liang, Rachelle Nuss, Susan Niermeyer, Megan Gossling, and Clyde Wright Copyright © 2017 Mauricio A. Palau et al. All rights reserved. Osteopathic Manipulative Treatment Limits Chronic Constipation in a Child with Pitt-Hopkins Syndrome Tue, 31 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/5437830/ Pitt-Hopkins Syndrome (PTHS) is a rare genetic disorder caused by insufficient expression of the TCF4 gene. Children with PTHS typically present with gastrointestinal disorders and early severe chronic constipation is frequently found (75%). Here we describe the case of a PTHS male 10-year-old patient with chronic constipation in whom Osteopathic Manipulative Treatment (OMT) resulted in improved bowel functions, as assessed by the diary, the QPGS-Form A Section C questionnaire, and the Paediatric Bristol Stool Form Scale. The authors suggested that OMT may be a valid tool to improve the defecation frequency and reduce enema administration in PTHS patients. Alessandro Aquino, Mattia Perini, Silvia Cosmai, Silvia Zanon, Viviana Pisa, Carmine Castagna, and Stefano Uberti Copyright © 2017 Alessandro Aquino et al. All rights reserved. A Pediatric Case of Cowden Syndrome with Graves’ Disease Tue, 31 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/2750523/ Cowden syndrome (CS) is a rare dominantly inherited multisystem disorder, characterized by an extraordinary malignant potential. In 80% of cases, the human tumor suppressor gene phosphatase and tensin homolog (PTEN) is mutated. We present a case of a 17-year-old boy with genetically confirmed CS and Graves’ disease (GD). At the age of 15, he presented with intention tremor, palpitations, and marked anxiety. On examination, he had macrocephaly, coarse facies, slight prognathism, facial trichilemmomas, abdominal keratoses, leg hemangioma, and a diffusely enlarged thyroid gland. He started antithyroid drug (ATD) therapy with methimazole and, after a 2-year treatment period without achieving a remission status, a total thyroidectomy was performed. Diagnosis and management of CS should be multidisciplinary. Thyroid disease is frequent, but its management has yet to be fully defined. The authors present a case report of a pediatric patient with CS and GD and discuss treatment options. Cláudia Patraquim, Vera Fernandes, Sofia Martins, Ana Antunes, Olinda Marques, José Luís Carvalho, Jorge Correia-Pinto, Carla Meireles, and Ana Margarida Ferreira Copyright © 2017 Cláudia Patraquim et al. All rights reserved. Neonatal Liver Failure and Congenital Cirrhosis due to Gestational Alloimmune Liver Disease: A Case Report and Literature Review Mon, 30 Jan 2017 12:05:21 +0000 http://www.hindawi.com/journals/cripe/2017/7432859/ Neonatal liver failure (NLF) is a major cause of neonatal morbidity and mortality, presenting as acute liver failure and/or congenital cirrhosis. Many affected patients show antenatal signs of fetal injury. There are several causes of NLF and early diagnosis is mandatory to elucidate the etiology and determine a specific treatment or the best management strategy. Gestational alloimmune liver disease associated with neonatal hemochromatosis (GALD-NH) is a rare but potentially treatable cause of NLF. It should be considered in any neonate with fetal signs of disease and postnatal signs of liver failure with no other identifiable causes. GALD-NH is often diagnosed late and patients are therefore referred late to specialized centers, delaying treatment. This case highlights the consequences of late diagnosis and treatment of GALD-NH and emphasizes the importance of a high grade of suspicion of this disease in order to refer the patient to a specialized center soon enough to perform the appropriate treatment. Carolina Roos Mariano da Rocha, Renata Rostirola Guedes, Carlos Oscar Kieling, Marina Rossato Adami, Carlos Thadeu Schmidt Cerski, and Sandra Maria Gonçalves Vieira Copyright © 2017 Carolina Roos Mariano da Rocha et al. All rights reserved. Idiopathic Pulmonary Hemosiderosis in a Child with Recurrent Macrophage Activation Syndrome Secondary to Systemic Juvenile Idiopathic Arthritis Mon, 30 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/5693501/ Macrophage activation syndrome, a severe complication of systemic juvenile idiopathic arthritis and other inflammatory diseases, represents one of the most important rheumatological emergencies. Delayed diagnosis could lead to life-threatening complications. Pulmonary hemosiderosis has been classically characterized by a triad of anemia, hemoptysis, and lung infiltrates on chest radiogram. Although the majority of patients of pulmonary hemosiderosis are considered idiopathic, secondary hemosiderosis associated with known diseases could be seen. In this case report, we aimed to present gradually increased pulmonary manifestations due to pulmonary hemosiderosis with recurrent macrophage activation syndrome attacks in a child with systemic juvenile idiopathic arthritis. Kenan Barut, Sezgin Sahin, Amra Adrovic, Velat Sen, and Ozgur Kasapcopur Copyright © 2017 Kenan Barut et al. All rights reserved. Acute Hemorrhagic Edema of Infancy after Coronavirus Infection with Recurrent Rash Tue, 24 Jan 2017 08:50:04 +0000 http://www.hindawi.com/journals/cripe/2017/5637503/ Purpura, particularly when accompanied by fever, is a worrisome finding in children. Acute hemorrhagic edema of infancy (AHEI) is a benign type of small-vessel leukocytoclastic vasculitis that presents with progressive purpura and has an excellent prognosis. Patients with AHEI present with large, target-like purpuric plaques affecting the face, ear lobes, and extremities. While the rapid onset of these skin findings can be dramatic, the child with AHEI is usually well appearing with reassuring laboratory testing. We describe a case of a previously healthy 8-month-old female who presented with progressive purpura in a nondependent distribution, low-grade fevers, and extremity swelling. An extensive workup was performed prior to making the diagnosis of AHEI. Coronavirus was implicated as the likely triggering pathogen, and the patient suffered a recurrence of purpuric rash and swelling several weeks after her initial presentation. Hannah Chesser, Jeffrey M. Chambliss, and Eric Zwemer Copyright © 2017 Hannah Chesser et al. All rights reserved. A Case of Neonatal Marfan Syndrome: A Management Conundrum and the Role of a Multidisciplinary Team Wed, 11 Jan 2017 07:47:29 +0000 http://www.hindawi.com/journals/cripe/2017/8952428/ Neonatal Marfan syndrome (nMFS) is a rare condition with a poor prognosis. It is genotypically and phenotypically distinct from the typical Marfan syndrome and carries a poorer prognosis. This case report describes the progression of a 14-month-old girl diagnosed with nMFS at 5 months of age. Her diagnosis followed the identification of a fibrillin-1 mutation (FBN1 gene, exon 26, chromosome 15), which is a common locus of nMFS. This patient developed severe cardiac complications resulting in congestive cardiac failure in early life and required major cardiac surgery. Since surgical intervention, our patient is still reliant on a degree of ventilator support, but the patient has gained weight and echocardiography has demonstrated improved left ventricular function and improved tricuspid and mitral valve regurgitation. Therefore, we argue the importance of a cautious multidisciplinary approach to early surgical intervention in cases of nMFS. Elliott J. Carande, Samuel J. Bilton, and Satish Adwani Copyright © 2017 Elliott J. Carande et al. All rights reserved. Rectal Bleeding and Abdominal Pain Following Vaccination in a 4-Month-Old Infant Mon, 09 Jan 2017 11:31:43 +0000 http://www.hindawi.com/journals/cripe/2017/9461315/ Intussusception is one of the most frequent causes of intestinal obstruction in infants. Rotavirus vaccination has been associated with intussusception in the medical literature. We report a case of a 4-month-old female with intussusception requiring hemicolectomy one week following rotavirus vaccination. We review the pathophysiology, presentation, and management of intussusception with a distinct focus on the history of rotavirus vaccination and risks of intussusception associated with timing of rotavirus vaccine administration. The discussion makes a strong case for rotavirus vaccine counseling regarding signs of intestinal obstruction and the importance of early recognition. Jaclyn Otero, Molly R. Posa, and Maria N. Kelly Copyright © 2017 Jaclyn Otero et al. All rights reserved. Management Challenges in a Child with Chronic Hyponatremia: Use of V2 Receptor Antagonist Mon, 09 Jan 2017 00:00:00 +0000 http://www.hindawi.com/journals/cripe/2017/3757423/ Chronic hyponatremia is very rare in children and is often seen in the setting of congestive heart failure or liver failure in adults. Here, we report an 8-year-old child with hypothalamic glioma who presented with severe hyponatremia. Initial management consisted of fluid restriction. This was very difficult for the child to follow and the child developed bizarre drinking habits requiring intervention from child psychiatry. So therapy was initiated with low dose V2 receptor antagonist under close inpatient monitoring. While initial response was reassuring, her sodium levels tended to drift down with longer duration of treatment requiring us to increase the dose frequently. Her response to therapy and her stable clinical situation off therapy suggest that she may have reset osmostat. Sowmya Krishnan, Swapna Deshpande, Ashwini Mallappa, Gunda Divya, Pascale Lane, Anu Vishwanath, and Rene Y. McNall-Knapp Copyright © 2017 Sowmya Krishnan et al. All rights reserved. Antituberculosis Drug-Induced Liver Injury with Autoimmune Features: Facing Diagnostic and Treatment Challenges Mon, 02 Jan 2017 07:36:06 +0000 http://www.hindawi.com/journals/cripe/2017/5741896/ The authors present a case report of antituberculosis drug-induced liver injury that offered diagnostic challenges (namely, the possibility of drug-induced autoimmune hepatitis) and treatment difficulties. Maria Adriana Rangel, Isabel Pinto Pais, Raquel Duarte, and Isabel Carvalho Copyright © 2017 Maria Adriana Rangel et al. All rights reserved. Neonatal Sacrococcygeal Neuroblastoma Mimicking a Teratoma Sun, 01 Jan 2017 11:16:17 +0000 http://www.hindawi.com/journals/cripe/2017/3624847/ We reported the first case of a congenital intrapelvic presacral neuroblastoma in Puerto Rico managed in the early neonatal period. The preoperative diagnosis was a sacrococcygeal teratoma Altman stage IV classification. This case confirms the importance of a comprehensive physical examination and observation of low-risk newborn infants with a history of adequate prenatal care and an unremarkable fetal ultrasonogram during pregnancy. Leticia Gely, Humberto Lugo-Vicente, María Correa-Rivas, Kary Bouet, Zayhara Reyes Bou, Mohammed Suleiman, and Inés García Copyright © 2017 Leticia Gely et al. All rights reserved.