Unusual presentation of primary iliopsoas abscess in an infant: a case report

Iliopsoas abscess (IPA) rarely occurs in newborns and infants. Symptom triad, including fever, inguinal swelling or discoloration, and limited lower limb movement, is observed in most cases. Herein, we report a case of unusual IPA in an 82-day-old boy who presented with fever as the only symptom. To our best knowledge, there have been no reports of infant IPA presenting without localizing signs. This report highlights the importance of a high degree of suspicion for timely diagnosis of infant IPA when an infant presents only with fever.

Rapidly Progressive Pericardial Effusion and Cardiac Tamponade in a Term Infant with an Umbilical Venous Catheter: A Case Report

Pericardial effusion (PCE) in neonates has various clinical presentations depending on the amount and speed of fluid accumulation and can cause cardiac tamponade (CT). We report a case of rapidly accumulating PCE and near-fatal CT with an umbilical venous catheter successfully resolved by emergent echo-guided pericardiocentesis in a term infant who had been hospitalized with meconium aspiration syndrome and persistent pulmonary hypertension. This case report suggests that if a patient with an intracardiac umbilical catheter shows sudden cardiopulmonary instability, the possibility of PCE and CT should be considered. Furthermore, if necessary, emergency drainage of the PCE and removal of the umbilical catheter should be immediately performed.

Exertional heat stroke-related rhabdomyolysis recurring twice in a 12-year-old boy athlete

Exertional heat stroke (EHS) is a life-threatening entity characterized by elevated core temperature with potential for multiorgan dysfunction. EHS-related rhabdomyolysis usually occurs in the early phase. We report a boy athlete with EHS-related rhabdomyolysis, which recurred 15 and 79 days after the initial event. This case indicates that EHS can cause recurrences of rhabdomyolysis along with persistent symptoms, which could hamper the return to daily activity. Children with EHS, particularly athletes, may be at risk for recurrent rhabdomyolysis.

An adolescent boy with epiploic appendagitis presenting with pain in the left lower quadrant lasting for more than 10 days

We report a case of a 14-year-old Korean boy presenting with pain in the left lower quadrant, persisting for over 10 days. Except for the persistent pain, no other symptoms, such as vomiting and diarrhea, were observed. In addition, laboratory findings were normal. He was eventually diagnosed with epiploic appendagitis, a rare disease in children. This case highlights the need for imaging study for early diagnosis of epiploic appendagitis or surgical emergencies in children who visit emergency departments with pain in the left lower quadrant without specific clinical findings.

A case of generalized tonic seizures related to acute myocarditis

It is challenging to clinically distinguish between convulsive syncope and true seizure. We describe a 7-year-old girl presenting with generalized tonic seizure caused by acquired complete atrioventricular block related to acute myocarditis. After hospitalization following 6 episodes of new-onset fever with seizure, she had a short episode of abrupt complete atrioventricular block followed by another generalized tonic seizure. The concentrations of cardiac enzymes were elevated, and her echocardiogram showed a decreased left ventricular function. This case underlines the necessity of cardiac investigations in children with convulsive syncope.

Echogenic Mass Lesion within the Main Pulmonary Artery in a Neonate

Here we present a rare case of pulmonary arterial thrombosis associated with a ductus arteriosus aneurysm that caused severe pulmonary stenosis. A 5-day-old newborn was admitted to our hospital for the evaluation of an intracardiac mass-like lesion found after the detection of a cardiac murmur. Echocardiography and heart computed tomography revealed a mass-like lesion measuring 8.1 mm in diameter across the distal main pulmonary artery to the proximal left pulmonary artery resulting in localized severe stenosis of the left pulmonary artery. Left pulmonary artery angioplasty for surgical resection of the thrombus revealed that the mass was adherent to the proximal part of the left pulmonary artery anterior wall and extended to the ductus arteriosus. Histological examination of the mass showed an old thrombus with dystrophic calcification. Five months after surgery, follow-up echocardiography showed that the left pulmonary artery peak pressure gradient had decreased but the proximal left pulmonary artery stenosis remained. Cardiac catheterization and balloon angioplasty suc cessfully relieved the pulmonary stenosis.

A case of generalized tonic seizures related to acute myocarditis

It is challenging to clinically distinguish between convulsive syncope and true seizure. We describe a 7-year-old girl presenting with generalized tonic seizure caused by acquired complete atrioventricular block related to acute myocarditis. After hospitalization following 6 episodes of new-onset fever with seizure, she had a short episode of abrupt complete atrioventricular block followed by another generalized tonic seizure. The concentrations of cardiac enzymes were elevated, and her echocardiogram showed a decreased left ventricular function. This case underlines the necessity of cardiac investigations in children with convulsive syncope.

Increased Levels of Interleukine-6, Interleukine-8, Interleukine-10 in Cerebrospinal Fluid in Children with Aseptic Meningitis / 대한소아신경학회지

PURPOSE: Cytokines play important roles on the expression of various neuronal inflammatory disease and insults. The purpose of this study was to evaluate the levels of interleukine (IL)-6, IL-8, IL-10 in cerebrospinal fluid (CSF) in children with aseptic meningitis and compare them with those of the patients having other acute neurological symptoms. METHODS: We retrospectively reviewed the medical records of the children who admitted in the pediatric department of Hanyang University Guri Hospital for acute neurological symptoms and had CSF examinations from September 2012 to July 2013. We classified them into six groups as acute encephalopathy, epilepsy, febrile convulsion, headache, infantile fever, and meningitis. We analyzed the clinical and laboratory data from them. RESULTS: A total of 87 CSFs of the patients were available. The levels of CSF IL-6, IL-8, and IL-10 were significantly increased in the group with aseptic meningitis group as compared to the other groups (P<0.05). CSF IL-6 (r=0.576, P=0.000), IL-8 (r=0.329, P=0.003), and IL-10 (r=0.523, P=0.000) were all significantly correlated with CSF White bood cell (WBC) count. Among the patients with aseptic meningitis, CSF enterovirus positive patients (CSF entero+) showed significantly increased IL-6, IL-8, IL-10 levels than CSF enterovirus negative patients (CSF entero-) (P<0.05). In addition, the CSF entero+ and the increase of IL-10 were significantly correlated (x2=6.827, P=0.033). CONCLUSION: In patients with aseptic meningitis, the CSF IL-6, IL-8 and IL-10 were more expressed than in other neurological disease group. Among them, the enteroviral meningitis may be more related with IL-6, IL-8 and IL-10 expression than in other causes of aseptic meningitis.

Clinical Characteristics of Symptomatic Clostridium difficile Infection in Children: Conditions as Infection Risks and Whether Probiotics Is Effective / 대한소아소화기영양학회지

PURPOSE: This study investigated the clinical presentations of symptomatic Clostridium difficile infection (CDI) in children. METHODS: We reviewed the medical records of 43 children aged 3 days, and the most frequently prescribed antibiotic was amoxicillin-clavulanate (35.7%). Twenty-eight patients were diagnosed with CDI despite taking probiotic supplements, most commonly Lactobacillus acidophilus (53.6%). The most common symptom was diarrhea (72.1%) at the time CDI was diagnosed. C. difficile was eradicated in 11 patients (25.6%) after treatment with oral metronidazole for 10-14 days, and in the two patients (4.6%) who required two courses of oral metronidazole. Sixteen patients (37.2%) showed clinical improvement without any treatment. CONCLUSION: This study showed the various clinical characteristics of CDI in children and that preexisting clinical conditions favored the development of CDI. In addition, CDI was found to occur in a number of patients even after probiotic prophylaxis given in conjunction with antibiotic therapy.