Etiologies and Clinical Characteristics of Cervical Lymphadenopathy in Children / 소아알레르기및호흡기학회지

PURPOSE:This study was performed to investigate clinical characteristics and the etiology of cervical lymphadenopathy in children. METHODS:A clinical review of 240 cases of children under the age of 18 who were admitted with cervical lymphadenopathy from January 2002 to December 2007. RESULTS:Cervical lymphadenopathy was diagnosed as follows:clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4 %), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%). Abscess was presented as an acute lesion (94.1%) with less than 2 weeks of fever (69.4 %) and tuberculous lymphadenitis was presented as a chronic lesion (62.5%) without fever (90 %). Malignant disease (100%) and necrotizing lymphadenitis (62.5%) were found in chronic lesion of older children with systemic symptoms (40% and 37.5%, respectively). Leukopenia (57.9%) with various duration of fever occured in case of necrotizing lymphadenitis. CONCLUSION:Clinically diagnosed lymphadenitis (52.1%), abscess (15%), necrotizing lymphadenitis (7.9%), reactive hyperplasia (5.4%), tuberculous lymphadenitis (4.2%), Kawasaki disease (2.9%) and malignancy (2.5%) were found in cervical lymphadenopathy. Although cervical lymphadenopathy was commonly caused by a benign infectious process, a more serious disease was not rare, which may have different clinical characteristics including age, duration of fever and disease, previous or accompanying symptoms, or white cell counts. Meticulous combination of clinical characteristics, history, physical examination and workup as well as follow-up may be the most important for the proper approach on cervical lymphadenopathy in children.

A rise and fall in AST and ALT level in nonspecific reactive hepatitis / 소아과

PURPOSE: The study was performed to assess the distribution of the diseases associated with nonspecific reactive hepatitis (NRH) for the past 10 years and to evaluate the change in the level of AST and ALT, and the difference by several variable factors. METHODS: From January 1997 to December 2006, 646 patients had elevated liver enzymes among 22,763 patients admitted to the Holy Family Hospital. We analyzed the difference in the age distribution, the period of elevated levels of AST and ALT, the resolution period, the peak value, the daily resolution value of AST and ALT, the sexual differences and the difference in several disease entities. One hundred and ninety-seven patients not confirmed as NRH or lost during follow-up were excluded. RESULTS: The prevalence rate of NRH was 2.84%. When compared to AST, ALT showed longer period of morbidity and resolution and the peak value was also higher in ALT. The male and female ratio showed significant value of 1.63:1. The morbid and resolution periods of AST and ALT between males and females were longer periods in males. The most prevalent disease entities were respiratory and gastrointestinal infections. Between the respiratory and the gastrointestinal diseases, the highest level of AST and ALT was observed in the respiratory disease. CONCLUSION: NRH is a common disease that occurs in 2.84% of the admitted pediatric patients. However, the pathogenesis and the progress of the disease have not been well known due to the lack of generalized information. Further research is necessary in the future.

Clinical Aspects of Necrotizing Pneumonitis Resulting from Mycoplasma pneumoniae Infection in Children / 소아알레르기및호흡기학회지

PURPOSE: Necrotizing pneumonitis is a complication of severe invasive lobar pneumonia characterized by necrotic foci in consolidated areas and its development may be due to excessive host cell-mediated immune response. Necrotizing pneumonitis caused by Mycoplasma pneumoniae (M. pneumoniae) in children and its successful treatment have been reported. We reviewed 5 cases to determine the disease course and outcome in pediatric patients with necrotizing pneumonitis resulting from M. pneumoniae infection. METHODS: Five patients with necrotizing pneumonitis caused by M. pneumoniae who were diagnosed and treated in the Department of Pediatrics, Uijeongbu St. Mary`s Hospital from January 2003 to December 2006 were reviewed in this study. Sex, age, clinical manifestations, laboratory and radiologic findings, treatments, and long-term follow-up outcomes of these patients were analysed retrospectively. RESULTS: One patient was a boy and others were girls. All were less than 5 years of age and had no immunocompromised conditions. Lower pH and glucose, higher protein and LDH were observed in pleural fluid. On the radiologic examinations, all had multilobar pneumonic involvements, especially in the right lobes and lower lobes. Necrotizing pneumonitis was diagnosed on chest CTs taken between two and 20 days following admission. The necrotic foci were identified as multiple low-attenuation changes within the contrast-enhanced consolidation areas mainly in the lower lobes of the affected side of lung. Cavitary necrosis was shown in 3 patients and persisted as pneumatoceles, which disappeared on the follow-up chest radiographs nearly up to 7 months following admission. Macrolide and broad-spectrum antibiotics were administered in all patients and chest tube drainage was performed in 2 patients. Systemic steroid therapy was added in 4 patients. Of those four, 2 patients, both under 2 years of age, improved more rapidly than others in clinical status and radiographic findings. In spite of steroid therapy, one patient died of acute respiratory distress syndrome. Consequently 4 patients were improved and discharged. Two patients who were under 2 ears were normalized and 2 patients who were 4 years of age showed remaining cavitation or fibrosis in the last follow-up chest radiographs. CONCLUSION: Our results may suggest though they are not yet proven nor have they been discussed extensively that younger patients show better prognoses than older children. Further well-designed and large scale studies may be warranted.