ABSTRACT
Thirty-three children with a diagnosis of systemic lupus erythematosus (SLE) were studied. At diagnosis, 29 of them (88%) were aged between 10 and 17 years and the other four (12%) between 5 and 9 years. The majority were girls (28, 82%) and the male:female ratio was 1:6.6. Children of East Indian and mixed racial origin formed the largest groups (37 and 39%, respectively) and mortality was higher in these two groups. The most common symptoms at diagnosis were: fever for > 1 week (75.8%), musculoskeletal symptoms (arthralgia, arthritis and myalgia (69.7%) and renal involvement (63.6%). Malar and discoid rashes were common, 39 and 37%, respectively. Central nervous system involvement at presentation was a rare but important cause of mortality. The mortality rate during follow-up was high at 39.3% and the commonest cause of death was renal failure. Childhood SLE is uncommon in Trinidad and Tobago. Diagnosis is often delayed because of the protean and non-specific manifestations. This study reports a higher prevalence, a more severe course and greater mortality in children of East Indian and mixed descent than in children of African origin. It also shows that the symptomatology at first presentation is consistent with other studies and should be recognised early. Early diagnosis and prompt and appropriate management are essential in order to reduce the high mortality still associated with SLE.
Subject(s)
Lupus Erythematosus, Systemic/diagnosis , Adolescent , Age Distribution , Cause of Death , Child , Child, Preschool , Developing Countries , Female , Follow-Up Studies , Humans , Lupus Erythematosus, Systemic/complications , Lupus Erythematosus, Systemic/ethnology , Lupus Nephritis/ethnology , Male , Prognosis , Sex Distribution , Trinidad and Tobago/epidemiologyABSTRACT
Thirty-three children with a diagnosis of systemic lupus erythematosus (SLE) were studied. At diagnosis, 29 of them (88%) were aged between 10 and 17 years and the other four (12%) between 5 and 9 years. The majority were girls (28, 82%) and the male:female ratio was 1:6.6. Children of East Indian and mixed racial origin formed the largest groups (37 and 39%, respectively) and mortality was higher in these two groups. The most common symptoms at diagnosis were: fever for > 1 week (75.8%), musculoskeletal symptoms (arthralgia, arthritis and myalgia (69.7%) and renal involvement (63.6%). Malar and discoid rashes were common, 39 and 37%, respectively. Central nervous system involvement at presentation was a rare but important cause of mortality. The mortality rate during follow-up was high at 39.3% and the commonest cause of death was renal failure. Childhood SLE is uncommon in Trinidad and Tobago. Diagnosis is often delayed because of the protean and non-specific manifestations. This study reports a higher prevalence, a more severe course and greater mortality in children of East Indian and mixed descent than in children of African origin. It also shows that the symptomatology at first presentation is consistent with other studies and should be recognised early. Early diagnosis and prompt and appropriate management are essential in order to reduce the high mortality still associated with SLE.
Subject(s)
Child , Humans , Lupus Erythematosus, Systemic/diagnosis , Lupus Erythematosus, Systemic/epidemiology , Lupus Erythematosus, Systemic/physiopathology , Trinidad and Tobago/epidemiologyABSTRACT
The case of a two-year-old boy with hypertensive encephalopathy secondary to Hepatitis B-associated polyarteritis nodosa is presented. Polyarteritis nodosa is a rare condition in children and its association with Hepatitis B viral infection is also rare.
Subject(s)
Hepatitis B/complications , Hypertensive Encephalopathy/etiology , Polyarteritis Nodosa/complications , Polyarteritis Nodosa/diagnosis , Antibodies, Antineutrophil Cytoplasmic/blood , Child, Preschool , Hepatitis B/diagnosis , Humans , Hypertensive Encephalopathy/diagnosis , Kidney/pathology , MaleABSTRACT
A 6-month-old infant presenting initially with clinical signs of bronchiolitis developed acute symptoms of large airway obstruction and respiratory failure despite treatment for bronchiolitis. Endotracheal intubation and oxygen therapy resulted in immediate and dramatic improvement of respiratory failure. Plain chest radiograph, computerized tomography and surgical biopsy with subsequent histological examination established that the respiratory failure was due to a mediastinal cystic hygroma.
Subject(s)
Humans , Male , Infant , Respiratory Insufficiency/etiology , Lymphangioma, Cystic/complications , Mediastinal Neoplasms/complicationsABSTRACT
A 6-month-old infant presenting initially with clinical signs of bronchiolitis developed acute symptoms of large airway obstruction and respiratory failure despite treatment for bronchiolitis. Endotracheal intubation and oxygen therapy resulted in immediate and dramatic improvement of respiratory failure. Plain chest radiograph, computerized tomography and surgical biopsy with subsequent histological examination established that the respiratory failure was due to a mediastinal cystic hygroma.
Subject(s)
Lymphangioma, Cystic/complications , Mediastinal Neoplasms/complications , Respiratory Insufficiency/etiology , Humans , Infant , MaleABSTRACT
57 children with idiopathic nephrotic syndrome who were seen at two hospitals in Trinidad between 1989 and 1995 (median follow-up period, 38 months) were classified according to their response to glucocorticoids. 27 (47%) were two to six years old at presentation; 37 (65%) were of East Indian descent, 7 (12%) were of African descent, and 12 (21%) were of mixed race. 55 (96%) responded to glucocorticoids. Renal biopsies in 15 patients revealed membranoproliferative glomerulonephritis and membranous nephropathy in the two patients who had not responded to glucocorticoids. Ten patients showed mesangial hypercellularity, associated with immunoglobulin deposits in 7 cases. Age, presentation with nephrotic features, mesangial hypercellularity and immunoglobulin deposits did not predict for unresponsiveness to glucocorticoids. These findings may be explained by the predominance of East Indians in the study group.
