Hepatitis A virus infection associated with bilateral pleural effusion, ascites, and acalculous cholecystitis in childhood: a case report.

BACKGROUND: Acute hepatitis A infection is common among children in developing nations. The clinical presentation in children is usually asymptomatic and anicteric, and it is a self-limiting infection. Rarely, it can be associated with extrahepatic complications such as pleural effusion, acalculous cholecystitis, and ascites. CASE PRESENTATION: An 8-year-old middle eastern child presented with abdominal pain, jaundice in the sclera, yellowish color of urine, and poor appetite. In the last two days, abdominal distension developed. After conducting diagnostic investigations, the child was diagnosed with HAV hepatitis associated with bilateral pleural effusion, acalculous cholecystitis, and ascites. He was managed conservatively with vitamin K supplementation and supportive parenteral fluids. After 4 days, clinical improvement was observed. CONCLUSION: Hepatitis A infections presented with extrahepatic manifestations like pleural effusion, acalculous cholecystitis, and ascites are very rare, especially in children. There have been some reports of these manifestations occurring in isolation, but for them to co-exist to our knowledge, this has only been reported in two cases in the literature, and this is the third case with all these three rare complications being presented simultaneously in a single child. Although HAV infection is an asymptomatic and self-limiting viral disease in childhood, it can manifest with rare extrahepatic complications, so pediatricians should be aware of this rare association to avoid unnecessary investigations.

Adrenocortical tumor manifesting as virilizing in a female child: Adenoma or carcinoma? A rare case report.

INTRODUCTION: Adrenocortical tumors (ACTs) are rare endocrine neoplasms in children, with functional ACTs being more prevalent than non-functional types. Clinical manifestations typically include virilization, Cushing's syndrome, and hyperaldosteronism. Surgical intervention is the primary treatment for ACTs, with a significant risk of recurrence in adrenocortical carcinoma even after complete resection. PRESENTATION OF CASE: This case presentation describes a 3.5-year-old female with generalized hirsutism and clitoral hypertrophy, leading to the discovery of a left adrenal tumor. The child underwent adrenalectomy, revealing a benign adrenal cortical adenoma. Unfortunately, due to loss of follow-up, the child later presented with pulmonary metastases and passed away, preventing further investigation into the source of metastases. DISCUSSION: Adrenocortical tumors are uncommon in children, with the classification of ACTs into adenomas and carcinomas. To our knowledge, this is the third case of an adrenocortical tumor in a child in Syria. We highlight the challenges in managing pediatric ACTs and emphasize the importance of timely intervention and close monitoring to improve outcomes. Regular follow-up is crucial to detect complications early and optimize treatment strategies, especially considering the unpredictable behavior of these tumors. CONCLUSION: This case confirms that distinguishing between adrenocortical adenoma and carcinoma can be challenging even histologically. Therefore, it is necessary to follow up after treating each case of adenoma in a child to prevent major complications.

Seroprevalence of brucellosis antibodies and associated risk factors among the hospitalized patient, Aleppo, Syria: a hospital-based cross-sectional study.

Introduction and importance: Brucellosis is one of the most common infectious diseases in the world, especially in developing countries. Recent reports show that Syria is among the top ten countries where brucellosis is most prevalent. The purpose of this study is to estimate the seroprevalence of brucellosis antibodies among the hospitalized patients, in one of the largest hospitals in northern Syria. Materials and methods: A cross-sectional study was conducted among the hospitalized patients. The authors used a questionnaire to collect sociodemographic and brucellosis-related data from the patients. The authors also collected blood samples from these patients to be screened for brucellosis antibodies using Wright Coombs Agglutination and 2-mercaptoethanol tests, during the period from November 2021 and March 2022. Results: Among the 776 patients who were recruited in the study, the seroprevalence of brucellosis antibodies was 13.1% (n=776). The highest prevalence was among the female sex (16.7%, n=298), middle aged group 12-40 years (24.1%, n=116), and patients with history of brucellosis (30.1%, n=53). Among the positive samples, the findings of 2-mercaptoethanol tests show that (14.7%, n=102) were positive (presence of IgG Antibodies), and (75.5%, n=102) were negative. Conclusion: This study is the first to describe the epidemiology of brucellosis in northern Syria. It clearly shows high rates of positivity, which reflects immense challenges facing the public health sector in Syria. The best next step in light of this crisis is to raise awareness among population about brucellosis and its risk factor.

Successful surgical treatment of congenital chylous ascites co-existed with congenital hypothyroidism: A rare case report.

INTRODUCTION AND IMPORTANCE: Chylous ascites is a rare condition in children wherein milky fluid accumulates in the abdomen. It is caused by various factors and presents with abdominal distension. Diagnosis involves imaging and fluid analysis obtained through paracentesis. Treatment options range from conservative measures to surgery. The association with congenital hypothyroidism is not well-established. CASE PRESENTATION: A 3-week-old male infant presented with abdominal distention. Diagnosis revealed congenital chylous ascites and congenital hypothyroidism. Initially, he was treated conservatively with medium-chain triglycerides and total parenteral nutrition, paracentesis, and thyroid hormone supplementation. The patient's condition worsened, necessitating octreotide therapy, blood transfusion, and antibiotics. The conservative treatment failed, and the patient underwent surgery; however, the exact source of fluid leakage could not be identified. Follow-up ultrasound examinations showed no ascitic fluid in the subsequent months. CLINICAL DISCUSSION: Congenital chylous ascites can be caused by congenital malformations or idiopathic factors. Symptoms include abdominal distension and respiratory difficulties. Diagnosis involves imaging and fluid analysis through paracentesis. To our knowledge, this represents the third case of congenital chylous ascites in the associated with congenital hypothyroidism described in the literature and the first one to be treated with surgery. CONCLUSION: Treatment options range from conservative measures such as diet management and paracentesis to somatostatin therapy. Surgery is considered in refractory cases. An association between congenital hypothyroidism and congenital chylous ascites has been reported in few cases.