Severe dapsone hypersensitivity syndrome in a child / 소아과

Dapsone (4,4'-diaminodiphenylsulfone, DDS), a potent anti-inflammatory agent, is widely used in the treatment of leprosy and several chronic inflammatory skin diseases. Dapsone therapy rarely results in development of dapsone hypersensitivity syndrome, which is characterized by fever, hepatitis, generalized exfoliative dermatitis, and lymphadenopathy. Here, we describe the case of an 11-year-old Korean boy who initially presented with high fever, a morbilliform skin rash, generalized lymphadenopathy, hepatosplenomegaly, and leukopenia after 6 weeks of dapsone intake. Subsequently, he exhibited cholecystitis, gingivitis, colitis, sepsis, aseptic meningitis, disseminated intravascular coagulation, syndrome of inappropriate antidiuretic hormone secretion, pneumonia, pleural effusions, peritonitis, bronchiectatic changes, exfoliative dermatitis, and acute renal failure. After 2 months of supportive therapy, and prednisolone and antibiotic administration, most of the systemic symptoms resolved, with the exception of exfoliative dermatitis and erythema, which ameliorated over the following 4 months. Agranulocytosis, atypical lymphocytosis, aseptic meningitis, and bronchiectatic changes along with prolonged systemic symptoms with exfoliative dermatitis were the most peculiar features of the present case.

Clinical Features and Factors Associated with the Frequency of Phototherapy in Premature Birth Gestation < 35 Weeks and Birth Weight < or =2,500 g / 고신대학교의과대학학술지

OBJECTIVES: Clinical features according to the frequency of phototherapy and clinical risk factors on the number of phototherapy were investigated in premature births with gestation <35 weeks and birth weight < or =2,500 g. METHODS: The 186 infants with gestation <35 weeks and birth weight < or =2,500 g were admitted to the neonatal intensive care unit of Kosin University Gospel Hospital from March 2009 to August 2010. The 171 infants were alive and had jaundice requiring phototherapy. Phototherapy was usually started to 50-70% of the maximal bilirubin level. They were divided into two groups according to the frequency of phototherapy as single phototherapy group (group I) and multiple phototherapy group (group II). We retrospectively reviewed the medical records of all patients. RESULTS: The mean gestational age and birth weight of group I were 31.0+/-2.9 weeks and 1,596+/-485 g and those of group II were 31.1+/-2.6 weeks and 1,592+/-430 g. Compared with group I, albumin and Apgar score at 1 minute of group II were significantly higher and the day of peak bilirubin was also late. Duration of phototherapy in group II was statistically longer than that group I but duration of ventilator and aminophylline use for apnea was significantly shorter. The frequency of antibiotic use, incidence of bronchopulmonary dysplasia (BPD), and intraventricular hemorrhage (IVH) of group II were significantly lower than those of group I. CONCLUSIONS: The day of peak bilirubin was late and the frequency of antibiotic use, incidence of BPD, and IVH were low in group II. The aggressive phototherapy may be considered in premature births with jaundice.

Assessment of Iron Parameters in Children with Acute Infectious Disease / 임상소아혈액종양

BACKGROUND: As some parameters reflecting iron status were known to change with infection or inflammation, we examined the changes of these parameters in children with minor illnesses.METHODS: Hematologic tests were done in 42 young children with acute infection. Iron deficiency anemia (IDA) was defined as having Hb less than age-matched normal range, MCH <27 pg, and either Tfsat (transferrin saturation) <10% or TIBC >360 microg/dL. Iron deficiency (ID) was defined as having Hb equal or more than age matched normal low limit with MCH <27 pg, and either Tfsat <10% or TIBC >360 microg/dL. The others were classified as normal control (NC).RESULTS: The proportion of IDA, ID and NC were 16.6% (7/42), 33.3% (14/42) and 50.0% (21/42), respectively. Comparisons of means of Hb, MCV, MCH, and RDW between groups showed statistical difference in general, while levels of iron, ferritin and hs-CRP showed no statistical difference. Mean blood levels of zinc protoporphyrin (ZnPP) of IDA, ID and NC were 72.21 microg/dL, 57.02 microg/dL, and 45.62 microg/dL, respectively, but the difference was significant only between IDA and NC. ZnPP was inversely correlated with MCV (r=-0.518, P<0.01) and RDW (r=-0.640, P<0.01), but not with hs-CRP or ferritin.CONCLUSION: Combination of RBC indices with newly controlled Tfsat or TIBC can be available for an iron status assessment in children with minor infections. ZnPP levels in blood reflect some aspect of iron status, while ferritin and iron do not reflect it.

Assessment of Iron Parameters in Children with Acute Infectious Disease / 임상소아혈액종양

BACKGROUND: As some parameters reflecting iron status were known to change with infection or inflammation, we examined the changes of these parameters in children with minor illnesses. METHODS: Hematologic tests were done in 42 young children with acute infection. Iron deficiency anemia (IDA) was defined as having Hb less than age-matched normal range, MCH 360 microg/dL. Iron deficiency (ID) was defined as having Hb equal or more than age matched normal low limit with MCH 360 microg/dL. The others were classified as normal control (NC). RESULTS: The proportion of IDA, ID and NC were 16.6% (7/42), 33.3% (14/42) and 50.0% (21/42), respectively. Comparisons of means of Hb, MCV, MCH, and RDW between groups showed statistical difference in general, while levels of iron, ferritin and hs-CRP showed no statistical difference. Mean blood levels of zinc protoporphyrin (ZnPP) of IDA, ID and NC were 72.21 microg/dL, 57.02 microg/dL, and 45.62 microg/dL, respectively, but the difference was significant only between IDA and NC. ZnPP was inversely correlated with MCV (r=-0.518, P<0.01) and RDW (r=-0.640, P<0.01), but not with hs-CRP or ferritin. CONCLUSION: Combination of RBC indices with newly controlled Tfsat or TIBC can be available for an iron status assessment in children with minor infections. ZnPP levels in blood reflect some aspect of iron status, while ferritin and iron do not reflect it.

Clinical characteristics of children with 2009 pandemic influenza A (H1N1) admitted in a single institution / 소아과

PURPOSE: This study aims to investigate the clinical characteristics of children diagnosed with the novel influenza A (H1N1) in the winter of 2009 at a single medical institution. METHODS: Out of 545 confirmed cases of influenza A (H1N1) in children, using the real time RT-PCR method at Kosin University Gospel Hospital from September to December of 2009, 149 patients and their medical records were reviewed in terms of symptoms, laboratory findings, complications and transmission within a family. RESULTS: Median age of subjects was 7 years (range: 2 months-18 years). New cases increased rapidly from September to reach a peak in November, then declined rapidly. Most frequently observed symptoms were fever (96.7%), cough (73.2%), rhinorrhea (36.9%) and sore throat (31.5%). Average body temperatures on the 1st, 2nd and 3rd hospital day were 38.75+/-0.65degrees C, 38.08+/-0.87degrees C and 37.51+/-0.76degrees C, respectively. Complete blood counts and biochemical tests performed on the first admission day showed within the reference values in most cases. Of the 82 patients with simple chest radiography, 18 (22%) had pneumonic lesions; multi-focal bronchopneumonia in eleven, single or multi-segmental lobar pneumonia in five, and diffuse interstitial pneumonia in two patients. All of the 149 patients improved from their symptoms and discharged within 9 days of admission without any late complication. CONCLUSION: Children with 2009 pandemic influenza A (H1N1) at our single institution displayed nonspecific symptoms and laboratory findings, resembling those of common viral respiratory illnesses, and did not appear to develop more severe disease.

A Case of Spindle Cell Carcinoma Originating from the Maxillary Sinus / 대한이비인후과학회지

Spindle cell (sarcomatoid) carcinoma of the upper respiratory tract is a rare malignancy, and its diagnosis, treatment, and prognosis still remain controversial. Histopathologic examination of this uncommon tumor shows surface epithelialcarcinoma and an underlying spindle-shaped proliferation. In the head and neck region, it is found predominantly in the larynx and oral cavity. To our knowledge, spindle cell carcinoma of the paranasal sinus has been rarely reported. We report a 57-year-old woman with a spindle cell carcinoma originating from the maxillary sinus. She was treated with surgery and post operative radiotherapy. After 8 months of close follow-up, she shows no sign of recurrence or distant metastasis. We offer this case and a review of the related literature in an effort to increase awareness of this rare malignancy.