Clinical Manifestation of Necrotizing Pneumonia in Healthy Children

OBJECTIVE: Necrotizing pneumonia (NP) is a severe complication of lobar pneumonia caused by various pathogens. The immunopathogenesis and clinical characteristics of NP in children are not clearly understood. We wanted to evaluate the clinical characteristics and suggest in part the immunopathogenesis of NP. METHODS: We reviewed retrospectively the medical charts and radiographic materials of eight patients with NP, who were diagnosed by chest radiography and chest computed tomography at the Department of Pediatrics, Soonchunhyang University Hospitals at Cheonan and Bucheon from January 2002 to December 2011. RESULTS: They were previously healthy, 2.1 to 4.6 years of ages (mean, 2.8+/-1.0 years) and three boys and five girls. All of them had pleural effusion. Five patients had pneumonic consolidations in right upper lung field. Three patients had pneumatocele. They developed leukocytosis (mean, 19,400+/-6,400/mm3), higher C-reactive protein level (mean, 25.1+/-8.0 mg/dL). The etiologic agents were revealed in two patients; Streptococcus pneumonia (S. pneumonia) was revealed in one patient and S. pneumonia and Mycoplasma pneumonia in the other patient. Three patients were treated with additional intravenous immunoglobulin. Clinical improvement was prolonged: fever lasted 10 to 23 days, and length of hospitalization was 15 to 36 days. NP or pneumatocele were completely resolved on the follow-up radiographic studies in all of the patients. CONCLUSION: Although the previously healthy young children with NP had protracted clinical course, they recovered without any problematic sequelae. Our results suggest that the immunopathogenesis of NP in children may be associated with the exaggerated immune reaction of the host to insults from initial bacterial infections, rather than the pathogen-induced cytopathies.

A Clinical Study of Child Abuse Present to In-hospital Child Abuse Center

OBJECTIVE: To promote awareness and efforts by in-hospital child abuse center to identity and prevent child abuse by investigation of victim and types of injury caused by child abuse. METHODS: A retrospective study was performed with 51 patients who had been diagnosed or suspected as child abuse at Shiny kid child abuse center in Soonchunhyang Gumi Hospital from January 2008 to December 2011. The medical records, radiologic documents, and social worker's notes were reviewed to investigate age, sex, type of abuse, perpetrator, type of injury, final diagnosis, and follow-up success rate. RESULTS: The mean age of the subjects was 7 years old. Twenty-one patients were between 1 and 6 years old, 14 patients between 7 and 12 years old, 12 patients over 13 years old, and 4 cases less than 1 year old. The sex distribution was 47% (n=24) of male and 53% (n=27) of female. Thirty-five percentage of these patients reported with mixed abuse, 40% neglect, 29% physical abuse, 18% emotional abuse, 10.3% abandonment, and 2.5% sexual abuse, respectively. Twelve cases (23.5%) of them were found out the Routine health checkup. Bleeding and bruising (17.6%) were the second. Contusion and laceration were diagnosed in 9 cases, failure to thrive in 8 cases, tension headache in 5 cases, irritable bowel syndrome in 4 cases, sepsis of newborn in 4 cases, nephrotic syndrome in 3 cases, chronic otitis externa and media in 3 cases, mental retardation in 2 cases, congenital brain anomaly in 2 cases, major depression in 2 cases, pulmonary tuberculosis in 2 cases, diabetes mellitus in 1 case, and others in 6 cases, respectively. CONCLUSION: In-hospital child care team may experience the different proportion of abuse types and patterns by conducting a nation-wide survey of child abuse cases.

A case of antiepileptic drug hypersensitivity syndrome by lamotrigine mimicking infectious mononucleosis and atypical Kawasaki disease / 소아과

Antiepileptic drug hypersensitivity syndrome (AHS), a delayed immunological reaction, is a relatively rare side effect of antiepileptic drugs and is usually overlooked. An array of symptoms can occur one to eight weeks after treatment with an antiepileptic drug. Symptoms may be as simple as a fever, skin rash, or lymphadenopathy, but may eventually involve internal organs and cause fatal outcomes. Additionally, because the symptoms resemble the features of various arrays of diseases and the reported mortality rate is approximately 10%, the importance of early diagnosis and ability to differentiate AHS from other diseases cannot be overemphasized. We report a case of a 14-year-old girl with AHS caused by lamotrigine, which mimicked atypical Kawasaki disease and infectious mononucleosis.

A Case of Jacobsen Syndrome

Jacobsen syndrome is a clinical disorder characterized by a deletion of the terminal band 11q23. The features of the syndrome include growth retardation, psychomotor retardation, trigonocephaly, downward slanting palpabral fissures, retrognathia, micrognathia, hammer toes, thrombocytopenia and cardiac abnormalities. The disorder was first observed by Jacobsen in 1973. We herein report a case of Jacobsen syndrome in male premature neonate born with trigonocephaly, facial dysmorphism, cardiac defects and thrombocytopenia. The chromosomal study revealed 46, XY, del(11)(q23). The thrombocytopenia improved spotaneously by 3 months of age. The infant underwent a palliative operation for Tetralogy of Fallot at 11 months of age. A brief review of literature is included.

A Case of Jacobsen Syndrome

Jacobsen syndrome is a clinical disorder characterized by a deletion of the terminal band 11q23. The features of the syndrome include growth retardation, psychomotor retardation, trigonocephaly, downward slanting palpabral fissures, retrognathia, micrognathia, hammer toes, thrombocytopenia and cardiac abnormalities. The disorder was first observed by Jacobsen in 1973. We herein report a case of Jacobsen syndrome in male premature neonate born with trigonocephaly, facial dysmorphism, cardiac defects and thrombocytopenia. The chromosomal study revealed 46, XY, del(11)(q23). The thrombocytopenia improved spotaneously by 3 months of age. The infant underwent a palliative operation for Tetralogy of Fallot at 11 months of age. A brief review of literature is included.