Dengue shock syndrome

A three-and-half-year old indian boy, who had returned from Madras, was admitted with fever of five days' duration, vomiting of two days and altered sensorium of three hours prior to hospitalisation. He was investigated and was .empirically commenced on therapy for possible enteric fever. Later a raised haematocrit, thrombocytopaenia. hypoalbuminaemia, bilateral pleural effusion and tender hepatomegaly, prompted us to revise the diagnosis to possible dengue haemorrhagic fever/dengue shock syndrome [DHF/DSS], and this was subsequently confirmed by high titres of dengue virus antibodies. The child was treated conservatively, became asymptomatic and was sent home after ten days of hospitalisation. DHF/DSS remains a valid differential diagnosis in any child who presents with fever and circulatory collapse especially if there has been a visit to an endemic area. From our database, this is the first confirmed case of DHF/DSS from the Sultanate of Oman

Reversible central pontine myelinolysis in nephrotic syndrome

Central pontine myelinosys [CPM] is a pathological and clinical syndrome due to destruction of medullated sheaths with relative sparing of the axis cylinders and nerve cells in the pons. Clinicaly it is characterised by rapidly evolving quadriplegia and pseudobulbar palsy. In children, the most common etiology is the rapid correction of hyponatremia, and rarely other disorders like adrenal insufficiency, hyperglycaemic coma, liver disease and leukemia have been associated with CPM. The condition is often fatal and survivors have been reported to suffer from permanent neurological deficit in the form of 'locked in' stated. We report a girl who developed steroid resistant nephrotic syndrome, and during the course of her illness became hyponatremic also. Over enthusiastic correction of the latter, she developed CPM but recovered totally in a few days