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1.
SAGE Open Med Case Rep ; 11: 2050313X231220826, 2023.
Article in English | MEDLINE | ID: mdl-38149118

ABSTRACT

Congenital mesoblastic nephroma is considered a tumour with favourable clinical behaviour with only few reported cases of metastases. We report an infant who underwent complete resection and later developed pulmonary metastasis. Ten-month-old baby girl initially presented at 3 weeks of age with macroscopic haematuria, hypertension and a lumbar mass. Contrast-enhanced computed tomography revealed a tumour arising from the left kidney without local invasion or metastasis. She underwent left nephrectomy. Immunohistochemistry confirmed a cellular type of congenital mesoblastic nephroma. At 10 months, she presented with difficulty in breathing. Contrast-enhanced computed tomography revealed an opacity in the right hemi-thorax. Histology of lung mass was suggestive of deposits from the previously excised mesoblastic nephroma. She developed a right-sided haemothorax and succumbed. This case report highlights the fact that even though congenital mesoblastic nephromas are considered tumours with favourable clinical behaviour, they can present later with distant metastasis. Therefore, clinicians need to be aware of this rare malignant potential and adhere to meticulous follow-up protocols.

2.
BMC Pediatr ; 22(1): 444, 2022 07 23.
Article in English | MEDLINE | ID: mdl-35870915

ABSTRACT

BACKGROUND: Kawasaki disease (KD) is a medium and small vessel vasculitis which usually has a good response to immunoglobulin therapy (IVIG). We present a case of incomplete KD with IVIG resistance associated with an unusual combination of vesicular guttate-psoriasiform rash, hypertension and late onset small joint arthritis. CASE PRESENTATION: A four-month-old male infant from Sri Lanka presented with high fever, conjunctival redness, pedal oedema and skin rash. He was found to have hypertension since admission with a high white cell count and high inflammatory markers. There was poor response to intravenous antibiotics and subsequent 2D echocardiogram revealed coronary artery aneurysms suggestive of KD. In the third week of illness he developed a vesiculo-papular rash involving face, trunk and limbs - which on biopsy revealed features of guttate psoriasis. Fever spikes continued and the coronary arteries showed progressive dilatation despite timely intravenous immunoglobulin administered on day 6 and methylprednisolone administered on day 10-13. Therapeutic response by means of reduction of fever was seen only after initiation of intravenous infliximab on day 28 of illness for which the fever responded within 24 hours. He developed a small joint arthritis of hands and feet on day 40 of illness which responded only after initiating methotrexate therapy. The hypertension persisted for 4 months after the onset of the illness before complete resolution. CONCLUSION: This case report depicts an unusual presentation of KD with a vesicular guttate-psoriasiform eruption, hypertension and late onset small joint arthritis. It highlights that clinicians should be aware of the fact that KD could present with such atypical manifestations and could develop unusual complications.


Subject(s)
Arthritis , Exanthema , Hypertension , Mucocutaneous Lymph Node Syndrome , Arthritis/complications , Arthritis/drug therapy , Exanthema/etiology , Fever/drug therapy , Humans , Hypertension/complications , Hypertension/etiology , Immunoglobulins, Intravenous/therapeutic use , Infant , Male , Mucocutaneous Lymph Node Syndrome/complications , Mucocutaneous Lymph Node Syndrome/diagnosis , Mucocutaneous Lymph Node Syndrome/drug therapy , Sri Lanka
3.
Case Rep Pediatr ; 2020: 8823611, 2020.
Article in English | MEDLINE | ID: mdl-33005469

ABSTRACT

Henoch-Schönlein purpura is a small vessel vasculitis that usually presents with palpable purpura, arthritis, abdominal pain, and nephritis. Subcutaneous oedema of dependent areas is common; however, oedema in the scalp is extremely rare especially in children older than two years. Here, we report a child with massive disfiguring scalp and facial oedema due to Henoch-Schönlein purpura. An eight-year-old boy presented with characteristic palpable purpuric rash and extensive disfiguring scalp and facial swelling for five days. He complained of blurred vision, vomiting, and severe headache on the day of admission. Examination revealed an ill child with extensive oedema of the face and scalp that was tender on palpation. His blood pressure was above the 99th percentile, and he had exaggerated deep tendon reflexes and extensor plantar responses. All biochemical investigations including renal function tests were normal. Noncontrast CT head showed normal brain, with marked soft tissue swelling of the scalp. Ultrasonography showed soft tissue oedema within and surrounding facial muscles without evidence of neck vessel compression. Urine analysis revealed microscopic haematuria on day 14 of the illness, and immunohistochemical staining of renal biopsy confirmed Henoch-Schönlein purpura nephritis. In conclusion, this case report presents a child with severe, disfiguring scalp and facial oedema due to Henoch-Schönlein purpura. It highlights that severe subcutaneous oedema of Henoch-Schönlein purpura can involve any part of the body not limiting to dependent areas.

4.
Sci Rep ; 10(1): 11856, 2020 07 16.
Article in English | MEDLINE | ID: mdl-32678248

ABSTRACT

Dengue induces a spectrum of severity in humans from the milder dengue fever to severe disease, or dengue hemorrhagic fever (DHF). Chymase is a candidate biomarker that may aid dengue prognosis. This prospective study aimed to identify whether warning signs of severe dengue, including hypovolemia and fluid accumulation, were associated with elevated chymase. Serum chymase levels were quantified prospectively and longitudinally in hospitalized pediatric dengue patients in Sri Lanka. Warning signs were determined based on daily clinical assessments, laboratory tests and ultrasound findings. Chymase was significantly elevated during the acute phase of disease in DHF or Severe dengue, defined by either the 1997 or 2009 WHO diagnosis guidelines, and persisted longer in the most severe patients. Chymase levels were higher in patients with narrow pulse pressure and clinical warning signs such as severe leakage, fluid accumulation, pleural effusion, gall-bladder wall thickening and rapid haematocrit rise concurrent with thrombocytopenia. No association between chymase and liver enlargement was observed. This study confirms that serum chymase levels are associated with DHF/Severe dengue disease in hospitalized pediatric patients. Chymase levels correlate with warning signs of vascular dysfunction highlighting the possible functional role of chymase in vascular leakage during dengue.


Subject(s)
Chymases/blood , Dengue Virus/pathogenicity , Hypovolemia/diagnosis , Pleural Effusion/diagnosis , RNA, Viral/blood , Severe Dengue/diagnosis , Thrombocytopenia/diagnosis , Biomarkers/blood , Child , Child, Preschool , Dengue Virus/genetics , Dengue Virus/isolation & purification , Female , Hospitalization , Humans , Hypovolemia/blood , Hypovolemia/pathology , Hypovolemia/virology , Longitudinal Studies , Male , Pleural Effusion/blood , Pleural Effusion/pathology , Pleural Effusion/virology , Prognosis , Prospective Studies , Severe Dengue/blood , Severe Dengue/pathology , Severe Dengue/virology , Severity of Illness Index , Sri Lanka , Thrombocytopenia/blood , Thrombocytopenia/pathology , Thrombocytopenia/virology , Viral Load
5.
Asian Cardiovasc Thorac Ann ; 28(4): 213-215, 2020 May.
Article in English | MEDLINE | ID: mdl-32276541

ABSTRACT

Cardiac complications following envenomation by Russell's viper venom are uncommon. We describe a 14-year-old girl who developed delayed-onset sinus node dysfunction. She presented with mucosal bleeding, ptosis, and muscle weakness. Her 20-min whole blood clotting time and international normalized ratio were prolonged. The initial electrocardiogram showed sinus tachycardia. Her systemic manifestations responded to antivenom serum. After 24 h, she developed bradycardia and electrocardiography showed sinus node dysfunction with sinus arrest and an atrial escape rhythm. This case shows that arrhythmias can have a delayed onset even after resolution of other systemic manifestations, and even after treatment with antivenom serum.


Subject(s)
Daboia , Heart Rate , Sick Sinus Syndrome/etiology , Sinoatrial Node/physiopathology , Snake Bites/complications , Action Potentials , Adolescent , Animals , Antivenins/therapeutic use , Electrocardiography , Female , Humans , Sick Sinus Syndrome/diagnosis , Sick Sinus Syndrome/physiopathology , Snake Bites/blood , Snake Bites/diagnosis , Snake Bites/therapy , Time Factors
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