Recurrent Kawasaki Disease.

Background: Recurrent Kawasaki disease is rare. Case characteristics: An eight-month old infant had classic Kawasaki disease with transient coronary artery dilatation. Observations: Recurrence of incomplete Kawasaki disease after two years of initial diagnosis. Outcome: The index episode of Kawasaki disease was resistant to single infusion of immunoglobulin, while repeat episode responded within 24 hours of institution of therapy. Message: Early recognition of recurrent Kawasaki disease requires a high index of suspicion.

Mature mediastinal teratoma- A rare cause of recurrent respiratory distress.

Teratomas are interesting because of their obscure origin,bizarre microscopic appearance and sometimes unpredictable behaviour.Although they occur infrequently in children, clinician should be aware of their clinical features, natural history, pathology and principles of treatment.In an attempt to document some of the features ,we report a case of an infant with large mediastinal teratoma presenting with severe and recurrent respiratory distress. Patient was operated successfully with no recurrence in 1 year follow up.

Occult hepatitis B virus infection as a cause of cirrhosis of liver in a region with intermediate endemicity.

BACKGROUND: Serological tests may fail to identify hepatitis B virus (HBV) infection as a cause of liver cirrhosis in a proportion of patients. The frequency of such occult infection in regions with intermediate HBV endemicity is not known. Such cases may be diagnosed by incremental testing for IgG anti-HBc, serum HBV DNA, and HBV DNA in liver tissue. METHODS: We tested sera of 111 patients with cirrhosis, including 39 with history of significant alcohol ingestion, for HBsAg, anti-HBc and serum HBV DNA. In addition, in a subset of 14 patients, HBV DNA was looked for in liver tissue. RESULTS: On HBsAg and anti-HBc testing, 66 patients had HBV infection. Serum HBV DNA testing identified HBV infection in 13 additional cases. Of 18 patients labeled as 'cryptogenic' on serological testing, HBV DNA was detected in the serum in 7 patients. Of 14 patients in whom paired liver tissue and serum specimens were tested, 4 additional patients with HBV infection were detected after liver biopsy analysis. CONCLUSIONS: Serological tests for HBsAg and anti-HBc antibody are insensitive in identifying HBV infection in patients with liver cirrhosis. HBV DNA testing in serum and liver can help in establishing HBV infection as etiology, either alone or in addition to another cause.