Microvillus inclusion disease as a cause of severe protracted diarrhea in infants.

There are many etiologies responsible for severe intractable diarrhea in infancy, for instance, autoimmune enteropathy, microvillus inclusion disease, tufting enteropathy, food allergy, post-enteritis syndrome, chronic intestinal pseudo-obstruction, Hirschsprung's disease, intestinal lymphangiectasia, congenital sodium or chloride diarrhea, and congenital enzymatic deficiency. This article reports a case of microvillus inclusion disease in a Thai patient. He presented with severe intractable watery diarrhea with persistent metabolic acidosis. After extensive investigation, the diagnosis of microvillus inclusion disease was made, based on the ultrastructural findings of microvillus inclusions in the cytoplasm of the enterocyte on electron microscopic study. Various treatments were introduced to the patient without clinical improvement, including cholestyramine, metronidazole, probiotics, and octreotide. He was dependent on total parenteral nutrition and subsequently died from TPN-related complications. Even though it is a rare disease, it should be considered if an infant has chronic secretory diarrhea.

A case report: Alagille syndrome.

Alagille syndrome consists of 5 major features comprising paucity of interlobular bile ducts, characteristic facies, posterior embryotoxon, vertebral defects and peripheral pulmonic stenosis. The female patient in this report met 4 of the 5 major features except ocular abnormality. The first clinical presentations were prolonged jaundice and generalized ecchymoses. She was treated by plasma replacement and vitamin supplement, particularly vitamin K1, which produced clinical improvement. This report also reviews the literature of Alagille syndrome.

Colonic carcinoma: a case report in a child and review literature.

This article reports one case of child colonic carcinoma. This is a rare disease in children which usually occurs in predisposing conditions, e.g. ulcerative colitis, familial polyposis coli, Gardner's syndrome, Turcot's syndrome and Peutz-Jegher's syndrome. The patient in this report was 12 years old. He presented with chronic intermittent colicky abdominal pain and uncorrectable iron deficiency anemia for 7 months prior to definite diagnosis. This report also reviews the literature about colorectal carcinoma in children. Physicians can make an early diagnosis with a high index of suspicion if they cannot explain clearly what causes abdominal pain. Further investigations should be performed, thereby, avoiding delayed diagnosis and improving survival rate.

Penicillium marneffei mesenteric lymphadenitis in human immunodeficiency virus-infected children.

Disseminated P. marneffei infection is one of the common opportunistic infections seen in HIV-infected patients in Southeast Asia. We report 3 cases of HIV-infected children with mesenteric lymphadenitis presented with prolonged fever and abdominal pain. The first two patients were diagnosed as peritonitis and acute appendicitis prior to exploratory laparotomy. Operative findings revealed multiple enlarged mesenteric lymph nodes. Histopathologic findings of mesenteric lymph nodes biopsy were characteristic for P. marneffei infection. Mesenteric lymphadenitis in the last patient was diagnosed by abdominal ultrasound. All three cases had positive blood and bone marrow cultures for P. marneffei. These patients were treated with amphotericin B. Fever declined in 3-6 days. The first two patients survived but the last one subsequently died from underlying hemophilia A (GI bleeding). CONCLUSION: Acute mesenteric lymphadenitis can be one of the unusual manifestations caused by P. marneffei. Southeast Asia is an endemic area for P. marneffei and is severely affected by acquired immunodeficiency syndrome epidemic. Therefore, mesenteric lymphadenitis should be considered in HIV-infected persons who present with prolonged fever and abdominal pain.