Eosinophilic gastroenteritis in an 18-year-old male with prolonged nephrotic syndrome / 소아과

Eosinophilic gastroenteritis is a rare disease characterized by prominent eosinophilic tissue infiltration of the gastrointestinal tract. Here, we report a case of eosinophilic gastroenteritis in an 18-year-old patient with prolonged nephrotic syndrome who presented with abdominal pain and peripheral hypereosinophilia. During the previous 2 years, he had visited local Emergency Department several times because of epigastric pain and nausea. He had been treated with steroid-dependent nephrotic syndrome since 3 years of age. Tests ruled out allergic and parasitic disease etiologies. Gastroduodenoscopy with biopsy revealed marked eosinophilic infiltration in the duodenum. Renal biopsy findings indicated minimal change disease spectrum without eosinophilic infiltration. The oral deflazacort dosage was increased, and the patient was discharged after abdominal pain resolved. To our knowledge, this is the first report of eosinophilic gastroenteritis in a patient with minimal change disease.

Achalasia Previously Diagnosed as Gastroesophageal Reflux Disease by Relying on Esophageal Impedance-pH Monitoring: Use of High-Resolution Esophageal Manometry in Children / 대한소아소화기영양학회지

Gastroesophageal reflux disorder (GERD) is the most common esophageal disorder in children. Achalasia occurs less commonly but has similar symptoms to GERD. A nine-year old boy presented with vomiting, heartburn, and nocturnal cough. The esophageal impedance-pH monitor revealed nonacidic GERD (all-refluxate clearance percent time of 20.9%). His symptoms persisted despite medical treatment for GERD, and he was lost to follow up. Four years later, he presented with heartburn, solid-food dysphagia, daily post-prandial vomiting, and failure to thrive. Endoscopy showed a severely dilated esophagus with candidiasis. High-resolution manometry was performed, and he was diagnosed with classic achalasia (also known as type I). His symptoms resolved after two pneumatic dilatation procedures, and his weight and height began to catch up to his peers. Clinicians might consider using high-resolution manometry in children with atypical GERD even after evaluation with an impedance-pH monitor.

Clinical Characteristics and Electroencephalogram in Children with Recurrent Headache / 대한소아신경학회지

PURPOSE: We compared clinical findings of headaches to find out important characteristics for the differential diagnosis of headaches. We tried to find out specific electroencephalogram (EEG) findings according to the types of primary headache and the relationship between clinical characteristics and EEG findings by analyzing EEGs of migraine. METHOD: We conducted a retrospective analysis by reviewing medical records of 275 patients who visited the Department of Pediatrics of Korea University Guro Hospital from November 2010 to October 2013. The headaches were classified according to the International Classification of Headache Disorders-II (ICHD-II). EEG was analyzed in relation to the type of headache. RESULTS: 245 (89.1%) were primary headache patients, and 30 (10.9%) were secondary headache patients.There were no differences in the frequencies of abnormal EEG findings according to the type of primary headache (P=0.855), and epileptiform discharge was most common abnormal EEG finding in the primary headache. Comparing the patients with epileptiform discharges to the patients with normal EEG finding in migraine, the patients showing epileptiform discharge were younger (P=0.035) and presented with occipital and atypical (i.e., not pulsating or pressing) headache (P=0.005). CONCLUSION: History and physical examination are the most important in the diagnosis of headache in children. There were no significant differences in EEG findings among the different types of primary headaches.However,we could find a relationship between clinical features of the migraine and its epileptiform discharge, so more studies correlating EEG findings to clinical features are needed in the future.

Idiopathic acute eosinophilic pneumonia in a 14-month-old girl / 소아과

Idiopathic acute eosinophilic pneumonia (IAEP), characterized by acute febrile respiratory failure associated with diffuse radiographic infiltrates and pulmonary eosinophilia, is rarely reported in children. Diagnosis is based on an association of characteristic features including acute respiratory failure with fever, bilateral infiltrates on the chest X-ray, severe hypoxemia and bronchoalveolar lavage fluid >25% eosinophils or a predominant eosinophilic infiltrate in lung biopsies in the absence of any identifiable etiology. We present a 14-month-old girl who was admitted to our pediatric intensive care unit because of acute respiratory distress. She had a fever, dry cough, and progressive dyspnea for 1 day. Chest X-ray showed multifocal consolidations, increased interstitial markings, parenchymal emphysema and pneumothorax. IAEP was confirmed by marked pulmonary infiltrates of eosinophils in the lung biopsy specimen. Most known causes of acute eosinophilic pneumonia, such as exposure to causative drugs, toxins, second-hand smoking and infections were excluded. Her symptoms were resolved quickly after corticosteroid therapy.