ABSTRACT
Isolated thyroid abscess is a rare entity in early childhood. Among thyroid disorders, thyroid abscess or acute suppurative thyroiditis constitutes about 0.7%-1% of all cases. The thyroid gland is normally resistant to infections due to its well-enveloped capsule, rich blood supply, and high iodine content.A child presented with tender neck swelling accompanied by fever for 3 days. Ultrasound of the neck showed features suggestive of left parapharyngeal abscess. Laboratory parameters including thyroid function test were within normal limits. Contrast-enhanced CT of the neck was done and showed an isolated thyroid abscess with no other abnormalities. The patient was started on intravenous antibiotics followed by incision and drainage of the abscess. The child improved symptomatically. This report discusses the differential diagnosis and management of this rare entity.
Subject(s)
Thyroid Diseases , Thyroiditis, Suppurative , Child , Child, Preschool , Humans , Abscess/complications , Thyroid Diseases/complications , NeckABSTRACT
The SARS-COV-2 pandemic led to the development of several vaccinations to contain the disease. The Pfizer-BioNTech COVID-19 (BNT162b2) vaccine was recommended on May 2021 for use in children above 12 years and older. The vaccine is safe, well tolerated and highly effective. Initial reports showed no serious adverse events; however, cases of myocarditis in young healthy male adolescents have been reported. We report two cases of myocarditis/perimyocarditis who presented with short history of chest pain following administration of the second dose of the MRN COVID-19 vaccine.
Subject(s)
BNT162 Vaccine , COVID-19 , Myocarditis , Adolescent , Child , Humans , Male , BNT162 Vaccine/adverse effects , COVID-19/prevention & control , Myocarditis/chemically induced , SARS-CoV-2ABSTRACT
Multisystem inflammatory syndrome in children (MIS-C) is a newly described syndrome related to the COVID-19, resembling other known aetiologies, including Kawasaki disease. Cardiovascular involvement is common; left ventricle dysfunction and coronary artery aneurysm (CAA) are also observed. Many treatment guidelines recommend using intravenous immunoglobulin (IVIG) alone or with glucocorticoids as the first-line therapy. Biological agents, such as anakinra, are recommended for refractory cases, but the evidence is still accumulating. Moreover, the use of other treatment agents can be beneficial, especially when anakinra is unavailable. Here, we report the case of a 9-year-old girl who presented with MIS-C with CAAs. She received cyclosporine because two rounds of IVIG treatment were ineffective and the use of anakinra is not approved in Japan. Her cytokine profile showed that cyclosporine prevented exacerbation. The case highlights that cyclosporine therapy can be an option for the treatment of refractory MIS-C with CAA.
Subject(s)
COVID-19 , Coronary Aneurysm , Mucocutaneous Lymph Node Syndrome , COVID-19/complications , Child , Coronary Aneurysm/complications , Coronary Aneurysm/drug therapy , Coronary Vessels , Cyclosporine/therapeutic use , Female , Humans , Immunoglobulins, Intravenous , Interleukin 1 Receptor Antagonist Protein/therapeutic use , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/drug therapy , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/drug therapyABSTRACT
A young girl in her teens presented with fever, rashes and various mucocutaneous symptoms. Flat erythematous macules were seen mainly on the limbs, without blisters or skin detachments. The lips were swollen with crusts and haemorrhage. The oral cavity and pharynx showed ulcerative lesions with exudate. Severe bilateral ocular lesions with pseudomembrane formation and corneal epithelial defects were present. Also, urogenital lesion and gastrointestinal symptoms with frequent haematochezia were observed. Her symptoms and pathological findings were consistent with Stevens-Johnson syndrome. She was treated with prednisolone and methylprednisolone pulse therapy. Her ocular and cutaneous symptoms improved without severe chronic complications. However, 1 month later, she developed dyspnoea, and a pulmonary function test revealed severe obstructive ventilation disorder. After discharge, she was regularly followed up for respiratory complications. High-resolution chest CT performed 9 months after onset revealed mosaic perfusions and bronchiectasis, consistent with bronchiolitis obliterans.
ABSTRACT
A 9-year-old boy presented with unbalanced gait, back pain and lower limb weakness. His physical examination revealed almost absent lower limbs reflexes and cerebro-spinal fluid (CSF) showed albuminocytologic dissociation. The brain and spine MRI with contrast illustrated abnormal enhancement-suggestive of Guillain-Barré syndrome.The case had limited distribution and it did not progress beyond the presenting clinical involvements. They did not need immunotherapy, self-recovered, managed conservatively using painkillers and gabapentin along with physiotherapy-with a wait and see approach. The child is now almost back to normal after 8-12 weeks.
Subject(s)
COVID-19 , Guillain-Barre Syndrome , Child , Guillain-Barre Syndrome/diagnosis , Guillain-Barre Syndrome/drug therapy , Humans , Immunotherapy , Magnetic Resonance Imaging , Male , SARS-CoV-2ABSTRACT
Vitamin D-resistant rickets shows the resistance to vitamin D (Vit-D) therapy, which traditionally works well in cases with deficiency rickets. The signs start appearing as early as in the first month of life and are characterised by the defective mineralisation at the ends of cartilage and bones despite having normal Vit-D levels in the serum. This case report highlights the dental and maxillofacial manifestations in a 3-year-old girl diagnosed with pseudo-Vit-D deficiency rickets. The report also highlights the variations in the dental manifestations of the condition reported in the literature.
Subject(s)
Familial Hypophosphatemic Rickets , Rickets , Vitamin D Deficiency , Bone and Bones , Child , Child, Preschool , Familial Hypophosphatemic Rickets/complications , Female , Humans , Rickets/diagnosis , Rickets/etiology , Vitamin D , VitaminsABSTRACT
We report on a unique case of a 7-year-old girl with new onset ocular myasthenia gravis shortly after recovery from multisystem inflammatory syndrome in children (MIS-C) temporally associated with SARS-CoV-2 infection. The diagnosis of myasthenia gravis was based on suggestive symptoms of fatigable bilateral orbital ptosis, diplopia, positive ocular cold compression test and serum acetylcholine receptor antibody positivity, as well as a favourable treatment response to pyridostigmine. The addition of corticosteroids and methotrexate resulted in complete resolution of the ocular signs.
Subject(s)
COVID-19 , Myasthenia Gravis , Child , Female , Humans , Myasthenia Gravis/complications , Myasthenia Gravis/diagnosis , Myasthenia Gravis/drug therapy , Receptors, Cholinergic , SARS-CoV-2 , Systemic Inflammatory Response SyndromeABSTRACT
We present the case of a 12-year-old African girl infected with SARS-CoV-2 who was admitted to a tertiary academic hospital in Johannesburg with severe acute inflammatory myositis complicated by rhabdomyolysis and acute kidney injury requiring renal replacement therapy and intensive care. She also fulfilled the diagnostic criteria for multisystem inflammatory syndrome in children.
Subject(s)
COVID-19 , Myositis , Rhabdomyolysis , Child , Female , Humans , Myositis/complications , Myositis/diagnosis , Rhabdomyolysis/complications , Rhabdomyolysis/diagnosis , SARS-CoV-2 , South Africa , Systemic Inflammatory Response SyndromeABSTRACT
Acute kidney injury (AKI) and nephrotic syndrome (NS) are uncommon manifestations of Epstein-Barr virus (EBV) mononucleosis. We report a 4-year-old boy with Infectious mononucleosis (IM) who presented with dialysis-requiring AKI and NS. Renal biopsy showed severe acute tubular necrosis, mild chronic interstitial nephritis and focal podocyte foot processes effacement. EBV early RNA was not detected in the renal tissue. However, immunophenotyping of peripheral lymphocytes showed increased cytotoxic T cell activity and increased memory B cells. Treatment with steroid led to rapid resolution of NS within 3 weeks. Renal function stabilised. EBV viral capsid antigen (VCA) IgM remained elevated until 4 months before starting to decline when VCA IgG and nuclear antigen started appearing. B lymphocytes are the predominant target cells in EBV infection and additionally may also act as antigen presenting cells to T lymphocytes, thereby eliciting the strong immune response and leading to podocyte and tubulointerstitial injury.
Subject(s)
Epstein-Barr Virus Infections/complications , Infectious Mononucleosis/complications , Nephritis, Interstitial/pathology , Nephrotic Syndrome/complications , Acute Kidney Injury/pathology , Acute Kidney Injury/virology , Antibodies, Viral , Child, Preschool , Humans , Immunoglobulin M , MaleABSTRACT
The current case report describes a 13-year-old young boy who presented with purpuric rashes following a completely asymptomatic COVID-19 infection and biopsy-confirmed leucocytoclastic vasculitis, mild haematuria and mild elevation of serum IgA. This case highlights one of the dermatological manifestations of COVID-19 infection which has not been reported so far. Paediatricians should explore the history of this infection when evaluating any child presenting with a vasculitic rash.
Subject(s)
COVID-19/complications , Vasculitis, Leukocytoclastic, Cutaneous/diagnosis , Adolescent , Asymptomatic Infections , Humans , Immunoglobulin A/blood , Male , Purpura , Vasculitis, Leukocytoclastic, Cutaneous/virologyABSTRACT
We herein report a case of a child with tuberculous meningitis and COVID-19 coinfection complicated by hydrocephalus, arterial ischaemic stroke and extensive cerebral sinus venous thrombosis. Both conditions induce a proinflammatory cytokine drive resulting, among others, in a prothrombotic state. The disruption of the coagulation system in this case was supported by elevated D-dimers, fibrinogen and ferritin levels, consistent with thrombotic complications reported in some adult patients infected with COVID-19. The child also exhibited prolonged viral shedding that suggests severe disease.