Coexistence of Rhabdomyolysis, Myocarditis and Arrhythmia after Spider Bite: A Case Report.

BACKGROUND: Rhabdomyolysis after spider bite has been reported in a small number of patients, and myocarditis in even fewer. However, arrhythmia associated with latrodectism in children has not been described in the literature to date. CASE SUMMARY: A girl presented approximately 4.5 h after being bitten on the left ankle by a black spider. Two unifocal premature ventricular contractions (PVCs) were observed on the electrocardiogram. In laboratory tests, creatine kinase was elevated. On day 2, levels of troponin, pro-brain and natriuretic peptide were elevated. Electrocardiogram revealed inverted and biphasic T waves. Echocardiography revealed mild left ventricular dilation, mitral and aortic valve regurgitation. Holter electrocardiogram showed PVCs. Her laboratory and echocardiography findings completely normalized after discharge, and no arrhythmia was observed on the Holter electrocardiogram during outpatient follow-up. CONCLUSION: Although spider bites are uncommon, they can cause serious systemic effects. These patients should be evaluated for arrhythmia, rhabdomyolysis and myocarditis.

Rarely, spider bites can cause serious systemic effects, severe morbidity and death. In a small number of patients, spider envenomation causes rhabdomyolysis and myocarditis. In the present case, the elevated troponin and pro-brain natriuretic peptide levels and electrocardiogram/echocardiography findings were consistent with myocarditis, and an increase in creatinine kinase level indicated rhabdomyolysis. In addition, the electrocardiogram and Holter electrocardiogram revealed unifocal premature ventricular contraction. To our knowledge, arrhythmia due to Latrodectus spider bite has not been described in children to date. In addition, this case demonstrates the coexistence of two serious systemic effects, rhabdomyolysis and myocarditis, with full recovery after appropriate treatment.

Prevalences of Allergic Disorders in Children with Terra Firma-Forme Dermatosis.

BACKGROUND: Terra firma-forme dermatosis (TFFD) is a clinical condition that may be defined as a dirty appearance of skin. Although it has been defined for many years, its clinical value is not well known. OBJECTIVE: We aimed to determine the prevalence of allergic disorders (asthma, allergic rhinitis, and eczema) to investigate if this clinical condition is associated with allergic disorders in children with TFFD. MATERIALS AND METHODS: A questionnaire descriptive of allergic disorders [International Study of Asthma and Allergies in Children (ISAAC)] was applied to all children diagnosed with TFFD at the pediatric clinics during a 6-month period specified for the study. The results were compared with the two ISAAC studies that have been previously conducted in our region. RESULTS: The prevalence of TFFD among 1695 children examined at our outpatient clinic was found to be 3.18% (n = 54). The youngest of the children was 6 months old and the oldest 13 years, with an average age of 6.08 ± 2.69 years. Our study group had significantly greater rates and intensities of lifetime wheezing, wheezing in the last 12 months (current wheezing), lifetime allergic rhinitis, allergic rhinitis in the last 12 months; and the rate of physician-diagnosed allergic rhinitis compared to the comparator groups (P < 0.005). CONCLUSIONS: The results support the view that TFFD may be a sign of associated asthma and allergic rhinitis.

Auditory brainstem response in children with iron deficiency anemia.

To investigate the neurosensorial influences with auditory brainstem response (ABR) in iron deficiency anemia. We recorded ABR in 33 children with iron deficiency anemia followed and in 31 healthy children (control group 1, 0-12 months, control group 2, 13-36 months, control group 3, 37-60 months) as a control group. The patients and controls were divided into three group: group I, at 12 months of age, group II, 13-36 months, and group III, 37-60 months. In all groups, composed latency time, inter-peak latency, amplitude of peaks, I-V wave amplitude ratio and waveform were evaluated and compared with control groups. In group I, I-V interpeak latency was increased compared with control group I (4.58 vs. 4.20 ms, p < 0.05). In group II, Wave V latency time and III-V interpeak latency were increased compared with control group 2 (6.21 ms vs. 5.63 ms. p < 0.005 and 0, 48 vs. 0.22 p < 0.005, respectively). In group III, wave I latency time was increased compared with control group 3 (1.56 ms vs. 1.46 ms) (p < 0.05). We considered that increases in ABR latencies might be explained by delayed maturation of myelinisation, which requires iron, and/or by dysfunction of iron containing enzymes.

Report of eight infants with acute infantile hemorrhagic edema and review of the literature.

Acute infantile hemorrhagic edema (AIHE) is a cutaneous leukocytoclastic vasculitis, clinically characterized by the symptom triad of fever, large purpuric skin lesions, and edema. The clinical picture has a violent onset, a short benign course, and spontaneous complete recovery. In this article, we present eight patients who were admitted with rashes on the skin and edema on the eyelids and extremities, and were diagnosed with AIHE according to their clinical and histopathological features (immunohistological study was also performed in three of them). Our purpose was to emphasize that, aside from Henoch-Schönlein purpura, meningococcemia, septicemia, and purpura fulminans, AIHE benign disorder should also be considered in the differential diagnosis to determine the clinical course and treatment protocol in patients with purpuric rashes.