Rotavirus-Induced Neonatal Seizures with Cerebral White Matter Abnormalities on Magnetic Resonance Imaging: A Case Report

Rotavirus is a major cause of acute gastroenteritis in infancy and early childhood. Febrile seizures can occur in some infants or children exhibiting rotavirus gastroenteritis even without severe electrolyte imbalance, hypoglycemia or abnormal cerebrospinal fluid (CSF) finding. Some reports have described diffuse cerebral white matter lesions on diffusion-weighted magnetic resonance imaging (DW-MRI) in neonates with rotavirus-associated encephalopathy/encephalitis. In this case study, a 6-day-old male neonate was transferred to the neonatal intensive care unit after having a fever lasting 24 hours. On hospital day two, the seventh day after birth, the patient had his first seizure. The pregnancy and delivery were uneventful. The lab findings, including a CSF exam, were normal, but a stool antigen test for rotavirus was positive. The electroencephalography (EEG) examination result was normal. DW-MRI of the brain showed bilateral symmetric diffusion restriction in the genu and splenium of the corpus callosum as well as in the periventricular white matter of the lateral ventricles. Multiple scattered high-signal-intensit foci on T1-weighted image/fluid-attenuated inversion recovery (FLAIR) in the periventricular white matter were also seen bilaterally. He is now 17 months old, and there were no further seizures. He did not show any neurodevelopmental delay. This case reports that the patient with rotavirus-induced neonatal seizures with cerebral white matter abnormalities on magnetic resonance imaging (MRI) showed a normal neurodevelopmental outcome on the follow-up.

The Incidence, Treatment and Risk Factors of Candidiasis in Very Low Birth Weight Infants

PURPOSE: Candidiasis is an important morbidity among very low birth weight infants (VLBWI). There is a little data on the risk factors in VLBWI. This study was done to describe the incidence, treatment, and risk factors of candidiasis in VLBWI. METHODS: From September 2008 to December 2011, medical records of 130 infants with VLBWI in Inje University Ilsan Paik hospital neonatal intensive care unit (NICU) were reviewed retrospectively. Seventeen infants were diagnosed with candidiasis and treated with antifungal agent. Patients were divided into the candidiasis group (CAN, n=17), the bacterial sepsis group (BAC, n=34), and the non-sepsis group (Non-SEP, n=74). Demographic findings and factors associated with candidiasis were compared between these groups. RESULTS: The mean gestational age was significantly low in the CAN group, but birth weight was not significantly different between the groups. The maternal demographic findings were not significantly different between the groups. The incidence of respiratory distress syndrome (RDS) is higher in the CAN group compared to these groups (P<0.05). The durations of intubation and central venous line were significantly longer in the CAN group than in the other groups (P<0.05). In the logistic regression analysis, the duration of central venous line is the significant factor for candidiasis (P=0.003, odd ratio: 1.56, 95% confidence interval: 1.39-1.68). CONCLUSION: The incidence of candidiasis in VLBWI was 13.1 % and the risk factor for candidiasis was longer duration of central venous line in our study.

Association Between Usual Vitamin K Intake and Anticoagulation in Patients Under Warfarin Therapy

This study aimed to explore the correlation between usual vitamin K intake and response to anticoagulant therapy among patients under warfarin therapy. We conducted a retrospective survey of patients (n = 50) on continuous warfarin therapy. Clinical information and laboratory parameters were sourced from medical records. Anticoagulant effect was evaluated by using the percent time in therapeutic range (TTR) and the coefficient of variation (CV) of International normalized ratio (INR). Dietary vitamin K intake was assessed using a semi-quantitative food frequency questionnaire that has been developed for the purpose of assessing dietary intake of vitamin K. A total of 50 patients aged between 21 and 87 years were included in the study. The mean vitamin K intake was 262.8 +/- 165.2 microg/day. Study subjects were divided into tertiles according to their usual vitamin K intake. The proportion of men was significantly higher in second and third tertile than first tertile (p = 0.028). The mean percent TTR was 38.4 +/- 28.4% and CV of INR was 31.8 +/- 11.8%. Long-term warfarin therapy group (> or = 3 years) had a higher percentage of TTR as compared to the control group ( 0.05). In conclusion, no significant association was observed between usual vitamin K intake and anticoagulant effects. Further studies are required to consider inter-individual variability of vitamin K intake. Development of assessment tools to measure inter-individual variability of vitamin K intake might be helpful.

A case of relapsing polychondritis and pyoderma gangrenosum in a patient with Down's syndrome / 대한내과학회지

Relapsing polychondritis (RP) is a rare multisystem disorder of unknown etiology that affects cartilaginous tissues, such as the auricular, nasal, and laryngotracheal cartilages. It may be accompanied by a wide spectrum of skin lesions, including erythema nodosum, erythema multiforme, and panniculitis. Pyoderma gangrenosum is a rare chronic cutaneous disease that usually presents as a painful nodule or pustule and progressively forms an enlarging ulcer. It may be associated with inflammatory bowel disease, rheumatoid arthritis, systemic lupus erythromatosus, leukemia, and myeloproliferative disorders. Pyoderma gangrenosum is rarely associated with RP. RP and pyoderma gangrenosum have been reported in a patient with myelodysplastic syndrome (MDS), and the appearance of skin lesions in MDS may herald its progression to acute myeloid leukemia. Here, we report the first case of RP coexisting with pyoderma gangrenosum in a patient with Down's syndrome.