case of pediatric gastrointestinal basidiobolomycosis mimicking Crohn's disease. A review of pediatric literature

Basidiobolomycosis is a rare fungal infection caused by basidiobolus ranarum. The vast majority of gastrointestinal basidiobolomycosis cases were reported from tropical and subtropical regions. We report a Saudi pediatric patient with ileal basidiobolomycosis and initial clinical presentation mimicking acute appendicitis before being misdiagnosed as Crohn's disease. Our case is the first to report effective treatment of pediatric gastrointestinal basidiobolomycosis using voriconazole mono-therapy. In addition, we present extensive review of pediatric gastrointestinal basidiobolomycosis in medical literature

Is there an association between type 1 diabetes in children and Gallbladder stones formation?

A number of studies in adults have evaluated the prevalence of gallstones in the diabetic population and showed a significant association with type 1 diabetes [T1D] and type 2 diabetes. The pediatric literature is limited to a single small case series. We conducted a cross-sectional study to evaluate for the presence of association between T1D in children and gallstones formation. Children diagnosed with T1D in a diabetic clinic have been examined for existence of gall bladder stone formation from November 2008 through November 2009. All have been subjected to the following: History, physical examination, blood tests [liver function tests, lipid profile, glycosylated hemoglobin [HbA1C]], and an ultrasound [US] of the gall bladder. One hundred and five children with T1D have been enrolled consecutively over a 1-year period: age ranged between 8 months and 15.5 years, 62 patients were females. The mean age at diagnosis was 6.3 +/- 2.9 years [range 0.85-11 years], mean duration of T1D was 2.2 +/- 2.1 years [range 0.2-8 years], mean body mass index was 16.5 +/- 3.4, mean HbA1c was 10.7 + - 2.4%, and 61.3% of patients had a HbA1c level >10%. The mean serum cholesterol was 4.16 +/- 0.75 mmol/L [normal 3.65-5.15 mmol/L] and mean serum triglyceride 1.02 +/- 1.3 mmol/L [normal 0-1.7 mmol/L]. Two patients had hyperlipidemia. US of the gallbladder did not show any case of gallstones or sludge formation. Data from our study do not show any association between T1D in children and gallstones formation, with diabetes duration of less than 8 years. The relatively short duration of diabetes and possibility that our study was underpowered might have been reasons for the absence of any association

Magnetic toy ingestion leading to jejunocecal fistula in a child

The accidental ingestion of a foreign body is a common problem in children, but ingestion of magnets is rare. When multiple magnets are ingested, they may attract each other and cause pressure necrosis through the bowel walls and eventually lead to serious complications like obstruction, perforation, and fistula formation. We report a case of a 5-year-old girl with jejunocecal fistula following ingestion of 2 magnet toys; it highlights the diagnostic challenge and the need for early surgical intervention in children especially when multiple magnets are ingested

Esophageal trachealization: a feature of eosinophilic esophagitis

Eosinophilic esophagitis [EE] is an inflammatory condition characterized by intense eosinophilic infiltration of the esophagus. EE is frequently misdiagnosed as gastroesophageal reflux disease. Here, we present a child with EE and a characteristic endoscopic finding, "ringed esophagus". An 11-year-old Saudi boy presented with dysphagia for 1 year. He had experienced an intermittent sensation of solid food sticking in his chest, which was relieved by drinking liquids. A barium swallow excluded anatomical causes of dysphagia, but revealed multiple-ringed esophagus. Endoscopy showed a furrowing and trachealizing appearance of the entire esophagus. Hisologically, extensive eosinophilic infiltration was a feature in biopsies obtained from the esophagus. The child responded well to a 2-month course of inhaled fluticasone. Symptoms recurred 3 months after discontinuation of therapy, which necessitated resumption of inhaled fluticasone. The endoscopic appearance of multiple esophageal rings should raise suspicion of EE and be confirmed by esophageal biopsies