ABSTRACT
@#We present a 15-year-old male with a two-year history of gynecomastia and a four-month history of gradually enlarging abdomen and right flank pain. Examination revealed severe stunting with breast mass Tanner Stage 3, penile stage 2, and hepatosplenomegaly. Laboratory investigations showed normal blood counts, liver function tests, alpha-fetoprotein, and beta-human chorionic gonadotropin. The imaging findings demonstrated multiple confluent masses in the liver, histologically diagnosed as fibrolamellar hepatocellular carcinoma.
Subject(s)
GynecomastiaABSTRACT
Background@#The features and outcome of hepatobiliary tuberculosis (HBTB) have not been extensively reported in children.@*Objective@#To describe the clinical, biochemical, radiologic, microbiologic and histologic features and outcome of children diagnosed with HBTB. @*Methods@#Data of HBTB patients aged 0-18 years were collected by review of medical records and as they were admitted. Cases were classified as bacteriologically-confirmed (positive AFB smear, TB culture or PCR of bile/liver tissue) or clinically-diagnosed (clinical, histologic and/or radiologic evidence). @*Results@#A total of 36 patients were included (mean age: 13yrs; 64% males): three bacteriologically-confirmed and 33 clinically-diagnosed. Most common signs/symptoms were weight loss (69%), fever (67%), hepatomegaly (61%) and jaundice (53%). Of the total, 68% had hypoalbuminemia, 50% increased transaminases and 47% prolonged prothrombin time. Fifteen (42%) patients were AFB positive on various microbiologic specimens. Most common imaging finding was hepatic calcification (64%). Of 11 patients with liver biopsy, seven (64%) had chronic/ granulomatous inflammation. All 36 were managed medically. Eight were lost to follow up, six died, and 22 (61%) are alive, nine with complete resolution of liver disease. @*Conclusion@#Hepatobiliary tuberculosis presents with non-specific clinical and biochemical findings. Several investigations are necessary to confirm the diagnosis. Overall response to anti-TB treatment is satisfactory with possible resolution of liver disease.
Subject(s)
Polymerase Chain Reaction , GranulomaABSTRACT
Se presenta el caso clínico de un infante de 2 años de edad, cuya progenitora lo llevó a consulta por presentar orinas oscuras y dolor abdominal en algunas ocasiones. Al examen físico se encontró hepatomegalia no dolorosa, que rebasaba en 2 cm el reborde costal derecho. En la ecografía abdominal se observaron múltiples calcificaciones hepáticas y la técnica de reacción en cadena de la polimerasa resultó positiva a citomegalovirus tanto en suero como en sangre. Los resultados de estos exámenes, así como los antecedentes de la madre y el niño permitieron diagnosticar una infección congénita por citomegalovirus. El paciente evolucionó favorablemente y hasta el momento de efectuado este artículo se mantenía asintomático
The case report of a 2 years child whose mother took to the outpatient service due to dark urines and abdominal pain in some occasions is presented. A non painful hepatomegaly was found in the physical examination that surpassed in 2 cm the right costal edge. Multiple hepatic calcifications were observed in the abdominal echography and the polymerase chain reaction technique, either in serum or blood, was positive to cytomegalovirus. The results of these exams, as well as the mother and child history allowed to diagnose a congenital infection due to cytomegalovirus. The patient had a favorable clinical course and he stayed asymptomatic up to the elaboration of this work
Subject(s)
Humans , Male , Child , Sepsis/congenital , Cytomegalovirus , Calcinosis , HepatomegalyABSTRACT
PURPOSE: Recently, with the improvement of techniques for antenatal ultrasonography, fetal intraabdominal calcifications have been increasingly detected. These findings are important because they can signify meconium peritonitis, intrauterine infection, or thromboembolism in hepatic or portal vein. So, we studied clinical course of fetuses and infants with intraabdominal calcifications prenatally and postnatally. METHODS: We analyzed retrospectively medical records of 47 mothers and their 38 children diagnosed with fetal intraabdominal calcifications at Cheil General Hospital & Women's Health Care Center, Kwandong University College of Medicine from January 2003 to December 2008. Fetal intraabdominal calcifications were divided into the two groups, 'extrahepatic-intraabdominal calcifications' and 'hepatic calcifications', and assorted again into 'simple type' and 'complicated type' respectively. And their clinical course and outcome were compared. RESULTS: Among 47 pregnant women with intraabdominal calcifications, 31 fetuses were suspected of meconium peritonitis, 12 revealed hepatic calcifications, and 4 had other calcifications. Seven pregnant women had lost to follow up, while 2 were intrauterine fetal demise and artificial termination of pregnancy, respectively. Thirty-eight babies were born and postnatal ultrasonography was done for 31 cases. The group of meconium peritonitis was divided into simple type (64.5%) and complicated type (35.5%). Among them, surgical treatments were needed for 2 infants, one had simple type and the other had complicated meconium peritonitis, respectively. The group of hepatic calcifications was divided into simple type (75%) and complicated type (25%). None of them needed any treatment and they showed good clinical course. CONCLUSION: Fetal intraabdominal calcifications are relatively frequent and benign disease with good clinical outcome. However, because of need for neonatal surgery, periodic and steady follow-up by ultrasonography is needed prenatally and postnatally.