Cardiac Pre-tamponade Secondary to Generalized Myxedema Due to Neglected Hashimoto's Thyroiditis in a Child With Down Syndrome.

Down syndrome (DS) is the most common chromosomal disorder in live-born infants, often associated with intellectual disability and various medical conditions, including thyroid dysfunction. Hashimoto's thyroiditis (HT), an autoimmune subtype, is a leading cause of acquired hypothyroidism in DS children. Severe hypothyroidism can precipitate myxedema, a critical condition linked to complications like pericardial effusion and cardiac tamponade. This case study presents a nine-year-old male with DS who was admitted for acute respiratory distress exhibiting classic signs of myxedema. Initial investigations revealed severe hypothyroidism and significant pericardial effusion. Surgical pericardiotomy drained 800 mL of fluid, confirming myxedema secondary to HT. Levothyroxine therapy led to progressive improvement, resolving myxedematous infiltrate and associated symptoms within a month. Follow-up at 12 months demonstrated sustained improvement with normalized thyroid function and no clinical disease activity. This case highlights an atypical presentation of HT in a DS child with cardiac pre-tamponade.

Clinico-Metabolic Profile and Follow-Up of Familial Cases Compared to Sporadic Cases in a Lyon Series of Type 1 Diabetic Children.

OBJECTIVE: This study aimed to describe the clinical, biochemical, therapeutic, and progressive characteristics of children with familial type 1 diabetes (T1D) compared to those with non-familial T1D. Compare within the first group, the phenotype of type 1 diabetics inherited from the father with those inherited from the mother. PATIENTS AND METHODS: We conducted a retrospective study lasting 10 years at the L'hôpital Femme Mère Enfant (Woman-Mother-Child Hospital) in Lyon, France. Cases were any child diagnosed with T1D for at least 12 months who had a parent with T1D. Each case was matched with a T1D control without a family history of T1D, of the same age, same sex and same year of discovery. Cases group was divided into two subgroups according to the sex of the parent with T1D. RESULTS: A total of 43 children had a TD1 parent (family group) of whom 27 cases were the father. Forty four T1D children without any T1D parent were matched (sporadic group). The family group had consulted earlier (p < 0.001), were less in initial diabetic ketoacidosis (p = 0.016), and had a lower HbA1C level lower (p < 0.001) and lower initial insulin requirements (p < 0.001). During follow-up, it was noted that the evolution of Hb1AC, insulin requirements, and chronic complications were similar in familial and non-familial cases (p = 0.943, p = 0.450, p = 0.664, respectively). The patients in the T1D mother group seemed better balanced than those of the T1D father with an average HbA1C at 10 years of follow-up of 7.82% in the maternal group compared to 9.10% in the paternal group (p = 0.021). CONCLUSION: This study shows that familial T1D is a protective factor against the initial severity of T1D in offspring. Paternal T1D presents a more severe initial and progressive clinico-biological character than T1D inherited from the mother. However, during follow-up, other psycho-environmental factors could modify this observation.

A Case of Cytomegalovirus Infection With Severe Thrombocytopenia in an Infant Who Was Successfully Managed With Antiviral Therapy.

Cytomegalovirus (CMV) is a member of the Herpesviridae family of DNA viruses. It is one of the major infectious causes that induce thrombocytopenia. We herein report a case of CMV infection in an infant complicated with severe thrombocytopenia that was successfully managed by antiviral treatment. A three-month-old girl presented with generalized petechial lesions in the limbs, trunk, and eyelids, discovered by chance during a vaccination consultation in an apyretic context. Blood examinations demonstrated thrombocytopenia at 26,000/mm3. She was diagnosed with immune thrombocytopenic purpura. Intravenous immunoglobulin was administered thrice and corticosteroid therapy at a dose of 2 mg/kg/day was started. The evolution during her hospitalization was marked by the increase to 373,000/mm3. A week later, the platelet had decreased again to 8000/mm3. Positive serology and high CMV DNA detected in serum by real-time quantitative polymerase chain reaction confirmed the diagnosis of CMV infection. In consideration of the severe thrombocytopenia, antiviral therapy with ganciclovir 5 mg/kg/12 hours was initiated. The platelet counts increased with decreasing CMV loads. She was discharged home after clinical stabilization with a close follow-up over one year.

Report of a New Case of Pentasomy X Revealed by Status Epilepticus.

This report describes an exceptional case of X (49, XXXXX) pentasomy in a girl aged three years and five months. She was admitted for recurrent seizures revealing epilepsy. She has growth failure and psychomotor retardation with a deformed face. The malformative assessment did not show any malformation apart from cerebral leukodystrophy. Pentasomy X is a very rare abnormality of the sex chromosomes. It only affects females, in whom three additional X chromosomes are added to the two X normally present. The pathogenesis of pentasomy X is not exactly clear, but it is probably caused by successive maternal nondisjunctions. Epilepsy and cerebral leukodystrophy are a new mode of revelation of this syndrome, never described in the literature.

New-Onset Diabetes with Ketoacidosis Precipitated by COVID-19 in Children: A Report of Two Cases.

BACKGROUND AND AIMS: There is growing evidence that the 2019 coronavirus disease (COVID-19) is emerging as a potential trigger virus for the development of diabetes mellitus in children. This can occur even in patients without factors predisposing to impaired glucose metabolism. Here, we report two rare cases of diabetic ketoacidosis revealing new-onset diabetes and precipitated by COVID-19. These cases are reported in view of their rarity and originality. The relationship between type 1 diabetes mellitus and COVID-19 is discussed. RESULTS: Two children developed symptoms suggestive of diabetic ketoacidosis preceded by polyuria, polydipsia, and asbestos. There is a documented COVID-19 infection in the parents of the 2 children. An asymptomatic infection was detected in the 2 patients on the basis of a reverse transcription polymerase chain reaction (RT-PCR) test. Thoracic imaging and inflammatory workup were negative in both cases. Both patients responded well to treatment, including rehydration regimens and intravenous insulin. On the 2nd day of their hospitalization, they were transferred to several injections of subcutaneous insulin with therapeutic and nutritional education from the parents. After about 4 weeks, their insulin requirements probably decreased due to the diabetes honeymoon. CONCLUSION: COVID-19 can induce acute onset diabetes and diabetic ketoacidosis in children. More research data are needed to improve our knowledge of this constellation and to guide the most appropriate therapies.

Acute pulmonary embolism in a child following SARS-CoV-2 infection: a case report.

In children, coronavirus disease 2019 infection is rarely symptomatic. Severe forms with respiratory distress are rare, thromboembolic complications are exceptional. We report a rare case of a 14 years old girl with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection who was admitted to the hospital for bilateral pulmonary embolism with intracardiac thrombus. The girl progressed well on anticoagulation.

[Effects of the COVID-19 Pandemic on childhood immunization in Morocco: electronic survey of 103 pediatricians]. / Impact de la pandémie COVID-19 sur la vaccination des enfants au Maroc: enquête électronique auprès de 103 pédiatres.

INTRODUCTION: no one can deny that vaccination against several serious diseases in the world, and particularly in Morocco, has given very satisfactory protective results. The extension of the COVID-19 pandemic in our country has led to a significant decline in childhood immunization, which could have severe repercussions increasing the risk of future outbreaks. Hence, the measures of the Ministry of Health to correct the situation. The purpose of this study was to highlight the extent of vaccine release during COVID-19 pandemic and to make recommendations to restore vaccination programmes. METHODS: we conducted a cross-sectional study of the effect of containment measures during this pandemic on the monitoring of children´s vaccinations. We conducted a national survey of pediatricians using an electronic questionnaire administered via Google Forms. We collected, analyzed and interpreted the results. RESULTS: one hundred and three Moroccan pediatricians answered the questionnaire. More than 2-thirds (78.6%) of pediatricians practiced in the private sector and delivered vaccines in the immunization schedule. The majority of pediatricians (95%) were asked about parental vaccine concerns. We noted that 82.5% of parents were reluctant to go to the local health department and 5.8% refused to take vaccination during COVID-19 pandemic. About 22% of pediatricians completely stopped immunization services and 72.8% delayed immunizations from 3 to 4 weeks. Vaccination stoppage involved older children in two thirds of cases. CONCLUSION: it is essential to maintain public confidence in vaccination. Ongoing and timely assessment of vaccine coverage as well as clear recommendations and broad public awareness are essential to respond to vaccine changes during the COVID-19 pandemic.

Severe SARS-CoV-2 Infection: A Multisystem Inflammatory Syndrome in Moroccan Children.

Until October 2020, children seem to have a mild form of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in Morocco. Since April 2020, a new entity of multisystem inflammatory syndrome in children associated with SARS-CoV-2 infection was reported in England, Italy, France, and the United States. This syndrome has similarities with the most frequent vasculitis in children, Kawasaki disease. Here, we describe the features and outcome of the first five cases of Kawasaki-like multisystem inflammatory syndrome in Moroccan children triggered by the SARS-CoV-2. The median age of the children was 7.8 years; three of them were boys. Criteria for Kawasaki disease were met in all of them with a complete presentation. Three patients required admission to a critical care unit with multi-organ failure in one of them, but no mortality occurred. They all received intravenous immunoglobulin (IVIG), a high dose of aspirin, methylprednisolone, and supportive therapy. Coronavirus 2019 disease (COVID-19) infection in children may be life-threatening; rigorous monitoring for several weeks is required in any positive child or living in a family cluster.

Acute Hepatitis and Pancytopenia in a Child With Chronic Abuse of Senna.

Long-term use of Senna and its anthraquinone glycosides has been associated with the development of hepatotoxicity in both children and adults. Our case study aims to present, for the first time, acute hepatitis associated with pancytopenia in relation probably to liver and bone marrow toxicity in a three-year-old child suffering from chronic abuse of Senna. We report the case of a three-year-old girl with a history of chronic constipation regularly treated with drinkable preparations made from the Senna plant and hospitalized eight months ago with an almost similar and reversible clinical presentation, probably of toxic origin. She was admitted to a pediatric intensive care unit with severe acute hepatitis and profound pancytopenia. Her first physical examination revealed an unconscious child with a Glasgow score of 11/15, generalized hypotonia, bleeding from the gum lining, facial erythrosis with peeling cheeks, hair loss (telogen effluvium), erythematous lesions ulcers of the anal margin, and fever. The myelogram performed two days after admission revealed a rich regenerative bone marrow with signs of inflammation. Besides, she developed deep vein thrombosis three days after placing her femoral catheter. Pancytopenia in hospitalized children is a rare but alarming situation. In our case, malignancy was excluded, as well as a severe infection. The cause of pancytopenia could be related to the toxic effects of Senna. Chronic use of Senna may be associated with bone marrow and liver toxicity and lead to deep vein thrombosis.

Primary Rhabdomyosarcoma of the Pleura: A Case Report and Review of the Literature.

Rhabdomyosarcoma is a malignant tumor of striated muscle tissue that can exceptionally present in the pleura. Its prognosis is generally poor. We report a case of an eight-year-old child admitted for a persistent dry cough which had progressed for three weeks, complicated by breathing difficulties and a deterioration in general condition. He had a history of recent contact with an uncle with pulmonary tuberculosis. Clinical examination on admission revealed right pleural effusion syndrome with moderate respiratory repercussion. The biological assessment shows moderate inflammation and a very high level of lactate dehydrogenase (LDH). Radiologically, there was abundant right pleurisy with intra-pleural nodular masses without ipsilateral pulmonary invasion or other distant localization. Pleural puncture reveals exudative lymphocytic fluid with negative tuberculous polymerase chain reaction (PCR) and atypical cells in cytology. Biopsy of the pleural mass showed pleural rhabdomyosarcoma of the alveolar type. The pet scan found bone metastases at two costal arches. After conditioning, the child received several courses of chemotherapy. The clinical and radiological outcome was favorable. This case is reported in view of its rarity and originality. We conclude that early diagnosis and treatment greatly improves the prognosis of this aggressive tumor.

The epidemiological and clinical profile of COVID-19 in children: Moroccan experience of the Cheikh Khalifa University Center.

INTRODUCTION: COVID-19 is an infectious disease caused by a new coronavirus. The first cases were identified in Wuhan. It rapidly spread causing a pandemic worldwide. The incidence and severity of this disease are likely to be different in children compared with adults. Few publications of COVID-19 in children have been published. Our Moroccan paediatric series is among the first studies on this disease in Africa. METHODS: We included all children with COVID-19 who were admitted and treated at the hospital from March 25 to April 26, 2020. We have collected information, including demographic data, symptoms, imaging data, laboratory results, treatments and clinical progress from patients with COVID-19. RESULTS: Since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Morocco, a total of 145 COVID-19 confirmed cases have been reported in the Cheikh Khalifa's Hospital. Among this cases, 15 children were registered. The median age of patients was 13 years. There were 7 boys and 8 girls. Five children are asymptomatic, 8 have mild symptoms and 2 have a moderate respiratory difficulty. The RT-PCR test results were positive in all patients. Radiologically, we found in 2 cases, multiple nodules with ground-glass opacities on the chest scan. The treatment was based on the combination of hydroxychloroquine and azithromycin. Evolution under treatment was good for all patients. CONCLUSION: This study describes the profile of COVID-19 in child in a Moroccan hospital and confirms that the severity of illness in children with COVID-19 to be far less than adults.

The epidemiological and clinical profile of COVID-19 in children: Moroccan experience of the Cheikh Khalifa University Center

Introduction: COVID-19 is an infectious disease caused by a new coronavirus. The first cases were identified in Wuhan. It rapidly spread causing a pandemic worldwide. The incidence and severity of this disease are likely to be different in children compared with adults. Few publications of COVID-19 in children have been published. Our Moroccan paediatric series is among the first studies on this disease in Africa. Methods: we included all children with COVID-19 who were admitted and treated at the hospital from March 25 to April 26, 2020. We have collected information, including demographic data, symptoms, imaging data, laboratory results, treatments and clinical progress from patients with COVID-19. Results: since the outbreak of 2019 novel coronavirus infection (2019-nCoV) in Morocco, a total of 145 COVID-19 confirmed cases have been reported in the Cheikh Khalifa's Hospital. Among this cases, 15 children were registered. The median age of patients was 13 years. There were 7 boys and 8 girls. Five children are asymptomatic, 8 have mild symptoms and 2 have a moderate respiratory difficulty. The RT-PCR test results were positive in all patients. Radiologically, we found in 2 cases, multiple nodules with ground-glass opacities on the chest scan. The treatment was based on the combination of hydroxychloroquine and azithromycin. Evolution under treatment was good for all patients. Conclusion: this study describes the profile of COVID-19 in child in a Moroccan hospital and confirms that the severity of illness in children with COVID-19 to be far less than adults