ABSTRACT
Background: Melanocytic nevi present at birth, or within the first few months of life, are defined as congenital melanocytic nevi (CMN). Neurocutaneous melanosis (NCM) is a rare disorder, represents pigment cell tumors of the leptomeninges, and occurs in association with large or multiple CMN. NCM carries an extremely poor prognosis. NRAS and BRAF V600E genetic mutations were reported in CMN. Our aim was to report 2 rare cases of NCM associated with large-sized CMN. Materials and Methods: Two cases were enrolled, a 19-month-old boy with multiple satellite and giant CMN (GCMN); and a 57-month-old girl with large CMN (LCMN). Both patients had central nervous system (CNS) symptoms, and therefore, were studied from clinical, radiological, and immunohistopathological aspects. Cytogenetic study was done for one of them. Results: Both patients had CMN located in the head/neck, with no cutaneous melanoma. MRI was the most reliable method for early detection of NCM. NCM was proved in the 2 studied cases by immunohistopathology performed after surgery. The boy with GCMN carried NRAS mutation at codon 61, in addition to the characteristic facial features relevant to RASopathies. Both patients died despite surgical intervention. Conclusion: Our report highlights the need for pediatricians to be alert to the risk of NCM in association with CMN, especially when a CMN lesion is large, or there are multiple satellite lesions, or the nevus location is at the head or neck. Moreover, in the setting of CMN, the absence of skin melanoma does not exclude the presence of NCM.
ABSTRACT
Asthma is the most common chronic disease of childhood. Specific immunotherapy is widely used in several countries for managing allergic asthma. Many clinical trials and a meta-analysis of several studies support its efficacy to reduce the symptoms and medical requirements. The purpose of this study was to clarify the efficacy of subcutaneous immunotherapy (SCIT) in improving the symptoms and reducing medication requirements in primary school children with asthma in comparison with pharmacotherapy. A single-blind, drug-controlled clinical trial was performed. A total of 242 primary school children with allergic asthma were included in the study. The patients were recruited from subjects attending the Allergic Center in Mosul City. Their age range was 7-12 years with mean age of 10 +/- 2 years. From the total only 197 children (81%) completed the study and were eligible for analysis, of those, 85 children were managed with SCIT and 112 children were managed with pharmacotherapies only. The follow-up after 1 year indicated that the children treated with SCIT show a marked reduction in the clinical symptoms, medication requirements, and the level of serum-specific IgE when compared with children treated with conventional drugs. SCIT was effective treatment and can prevent or decrease the onset of new sensitization to the offending allergen and maintain its beneficial effect for years after discontinuation.
