A Case of Epstein-Barr Virus Associated Encephalitis Improved after High-Dose Intravenous Immunoglobulin Therapy / 감염과화학요법

Neurologic complications of Epstein-Barr virus (EBV) infection are diverse including a number of neurologic diseases such as encephalitis, encephalomyelitis, Guillain-Barre syndrome, optic neuritis, acute disseminated encephalomyelitis, cerebellitis, and Alice-In-Wonderland syndrome. In general encephalitis caused by EBV in children has been considered a self-limited disease with few or no sequelae. Occasionally it leaves a severe neurologic sequela and complications. Therefore administration of high dose acyclovir and steroid in early stages of EBV encephalitis is recommended currently. In this case, the patient of a 8-year-old boy was admitted because of generalized tonic seizure of 2 times. He showed 16% of atypical lymphocytosis in peripheral blood smear and positive findings in VCA-IgM and EA-IgM tests. EBV DNA Antibody, and virus PCR in CSF was not evaluated. He also showed hepatosplenomegaly in abdominal sonography. Brain MRI revealed a bilateral increased signal intensity at lenticular nucleus and caudate nucleus, multiple high signal intensity at cortical layer of both gyrus reti, both frontal, inferior parietal, and dorsal aspect of the right paracentral lobue. As mentioned in serologic and imaging study, he was diagnosed as the EBV- associated encephalitis. Although we administered high dose acyclovir and corticosteroids, he showed clinical deterioration with confusion, delirium, and ataxia. Therefore, we administered additional high dose intravenous immunoglobulin, and finally he was recovered. We report the case of improvement of EBV-associated encephalitis after high-dose Intravenous immunoglobulin therapy.

A Case of Epstein-Barr Virus Associated Encephalitis Improved after High-Dose Intravenous Immunoglobulin Therapy / 감염과화학요법

Neurologic complications of Epstein-Barr virus (EBV) infection are diverse including a number of neurologic diseases such as encephalitis, encephalomyelitis, Guillain-Barre syndrome, optic neuritis, acute disseminated encephalomyelitis, cerebellitis, and Alice-In-Wonderland syndrome. In general encephalitis caused by EBV in children has been considered a self-limited disease with few or no sequelae. Occasionally it leaves a severe neurologic sequela and complications. Therefore administration of high dose acyclovir and steroid in early stages of EBV encephalitis is recommended currently. In this case, the patient of a 8-year-old boy was admitted because of generalized tonic seizure of 2 times. He showed 16% of atypical lymphocytosis in peripheral blood smear and positive findings in VCA-IgM and EA-IgM tests. EBV DNA Antibody, and virus PCR in CSF was not evaluated. He also showed hepatosplenomegaly in abdominal sonography. Brain MRI revealed a bilateral increased signal intensity at lenticular nucleus and caudate nucleus, multiple high signal intensity at cortical layer of both gyrus reti, both frontal, inferior parietal, and dorsal aspect of the right paracentral lobue. As mentioned in serologic and imaging study, he was diagnosed as the EBV- associated encephalitis. Although we administered high dose acyclovir and corticosteroids, he showed clinical deterioration with confusion, delirium, and ataxia. Therefore, we administered additional high dose intravenous immunoglobulin, and finally he was recovered. We report the case of improvement of EBV-associated encephalitis after high-dose Intravenous immunoglobulin therapy.

Clinical Usefulness of Serum Uric Acid in Gastroenteritis Patients with Dehydration / 대한소아소화기영양학회지

PURPOSE: The estimation of fluid deficit is crucial to the proper management of dehydrated children. Without well-documented serial weights on the same scale, the estimation of any given child's fluid deficit is imprecise and dependent largely on subjective clinical criteria. Despite the abundance of literature on clinical and laboratory evaluation of dehydration, few studies have focused on serum uric acid. So, we examined the usefulness of serum uric acid in gastroenteritis patients with dehydration. METHODS: Medical records of 90 gastroenteritis patients were retrospectively reviewed. By the body weight loss, we classified patients with mild, moderate, and severe dehydration groups. We studied the relevance of laboratory data (BUN, creatinine, serum bicarbonate, glucose, urine specific gravity, and uric acid) with dehydration. RESULTS: 54 children (60%) were dehydrated mildly, 24 (26%) dehydrated moderately, and 12 (14%) dehydrated severely. Statistically significant differences in BUN, creatinine, serum bicarbonate, glucose, and urine specific gravity could not be observed. But there was significant relationship between uric acid and the degree of dehydration. Data analysis suggested that the level of 7.0 mg/dL is the best cut-off value for predicting the development of moderate or severe dehydration. At this cut-off value, the sensitivity and specificity were 66.6% and 87.1%. CONCLUSION: Our study supports that the measurement of serum uric acid with traditional scales is useful for predicting the development of dehydration. But, in order to be used as the indicator for proper treatment at an earlier stage, further validation about serum uric acid is necessary.

Assessment of Ventricular Function Using Tissue Doppler Imaging in Kawasaki Disease

PURPOSE: The purpose of this study is to evaluate ventricular functional changes in Kawasaki disease using tissue Doppler echocardiographic measures with conventional echocardiographic measures. METHODS: Tissue Doppler imaging and conventional Doppler echocardiography were performed in 69 patients with Kawasaki disease and 39 healthy children. Peak velocities of systolic(Sa) and early(Ea), late(Aa) diastolic motion of mitral annulus were obtained at the lateral and septal side from apical 4 chamber view. RESULTS: Sa(7.7+/-1.8 cm/s vs 8.8+/-2.1 cm/s, P=0.01) and Ea(15.7+/-3.2 cm/s vs 17.2+/-3.3 cm/s, P=0.03) measured at lateral mitral annulus were significantly lower in patients with Kawasaki disease. Aa(7.0+/-2.0cm/s vs 6.2+/-1.3 cm/s, P=0.01) measured at septal mitral annulus were statistically higher in patients with Kawasaki disease. There was no significant difference in coronary arteriopathy patients compared with non-coronary arteriopathy patients in Kawasaki disease. In conventional mitral and pulmonary venous flow velocities, there was significant difference of E in Kawasaki disease patients. The ratio of E/Ea and flow propagation velocity(Vp) demonstrated difference in Kawasaki disease patients. CONCLUSION: Peak mitral annular velocities obtained by tissue Doppler imaging were significantly altered in acute phase of Kawasaki disease. Tissue Doppler imaging with conventional Doppler echocardiography can be a promising method for evaluation of ventricular function in patients with Kawasaki disease.