ABSTRACT
Background: Pericarditis is rare in Coronavirus disease 2019 (Covid-19) infection and only a few cases were reported in children. Case presentation: We present the case of a 15-year-old boy with symptoms of high fever and worsening chest pain during COVID-19 infection. Chest computer tomography (CT) and echocardiography confirmed pericardial tamponade requiring urgent drainage. Despite antiviral drug treatment, after 18 days severe attack developed requiring repeated pericardiocentesis. High dose ibuprofen, colchicin and the interleukin-1 antagonist, anakinra were given. Clinical symptoms and laboratory parameters improved after seven days of treatment. Autoinflammatory diseases were also suspected in the background the severe pericarditis, but genetic analysis ruled out any mutations. Conclusion: Pericarditis associated with COVID-19 infection may present in the acute phase or later as MIS-C. Though pericardial tamponade related to ongoing Covid-19 infection is rare in children, even biological treatment with interleukin-1 antagonist may be needed to control the inflammation.
ABSTRACT
We report on an 11-year-old girl with cystic fibrosis who presented with thoracic pain and an extensive subcutaneous emphysema and subsequently developed progressive respiratory distress. The chest computed tomography revealed a huge pneumomediastinum. Due to the development of severe respiratory failure, urgent needle thoracocentesis was necessary that resulted in only temporary improvement. Therefore, under general anesthesia two mediastinal drains were introduced. Using active suction, the size of the pneumomediastinum decreased gradually and the drains were removed after 3 weeks. Here, we describe an extremely rare situation, when acute surgical intervention was necessary in a child with spontaneous pneumomediastinum.
ABSTRACT
Anti-N-methyl-D-aspartate encephalitis is an autoimmune disorder characterized by autoantibodies produced against NMDA receptors. We report the case of a 17-year-old drug user teenager who presented with altered mental scale, psychiatric symptoms and autonomic dysfunction. In the background we diagnosed NMDA encephalitis. We supposed that synthetic cannabinoids/drugs may have lead to the of trigger NMDA encephalitis via the altered activation of the immune system and molecular mimicry mechanism.
Subject(s)
Anti-N-Methyl-D-Aspartate Receptor Encephalitis/etiology , Substance-Related Disorders/complications , Adolescent , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/complications , Anti-N-Methyl-D-Aspartate Receptor Encephalitis/diagnosis , Autoantibodies , Humans , Mental Disorders/etiology , Molecular Mimicry , Receptors, N-Methyl-D-AspartateABSTRACT
A 12-year-old girl developed acute erythromelalgia of distal extremities. Physical, imaging and laboratory examinations failed to find an infective, systemic autoimmune, metabolic, endocrine, and vascular origin. The severe pain and allodynia indicated small-fiber neuropathy but muscle weakness suggested an involvement of large myelinated nerve fibers. This was confirmed by electrophysiological testing. High-dose then slowly tapered methylprednisolone resulted in rapid remission of painful erythromelalgia and complete electrophysiological recovery. Our case may suggest an additional variant to recently described steroid-responsive erythromelalgia with small-fiber axonopathy and may denote a transitory variant to Guillain-Barré syndrome or chronic dysimmune neuropathies.
Subject(s)
Autoimmune Diseases of the Nervous System/pathology , Erythromelalgia/immunology , Erythromelalgia/pathology , Nerve Fibers, Myelinated/pathology , Peripheral Nervous System Diseases/immunology , Peripheral Nervous System Diseases/pathology , Acute Disease , Age of Onset , Autoimmune Diseases of the Nervous System/physiopathology , Axons/pathology , Child , Erythromelalgia/drug therapy , Extremities/innervation , Extremities/physiopathology , Female , Humans , Motor Neurons/immunology , Motor Neurons/pathology , Muscle Weakness/immunology , Muscle Weakness/pathology , Muscle Weakness/physiopathology , Neuralgia/immunology , Neuralgia/pathology , Neuralgia/physiopathology , Peripheral Nerves/pathology , Peripheral Nerves/physiopathology , Peripheral Nervous System Diseases/physiopathology , Skin/innervation , Skin/pathology , Skin/physiopathology , Steroids/pharmacology , Steroids/therapeutic use , Treatment Outcome , Wallerian Degeneration/immunology , Wallerian Degeneration/pathology , Wallerian Degeneration/physiopathologyABSTRACT
Lung resection for benign diseases in infants is an extremely difficult thoracic surgical decision. Paediatric patients with drainage resistant pneumothorax and/or pneumatocele due to destroyed lung pose an even more challenging task. We describe a parenchyma sparing method using a sealant-haemostatic complex foam (Tachosyl) developed originally for application in liver and kidney surgery. Both small patients with secondary pneumothorax were operated on successfully.
Subject(s)
Fibrinogen/therapeutic use , Pneumothorax/surgery , Thrombin/therapeutic use , Bronchopneumonia/complications , Bronchopneumonia/diagnostic imaging , Drug Combinations , Empyema, Pleural/surgery , Female , Humans , Infant , Male , Pneumothorax/diagnostic imaging , Pneumothorax/microbiology , Surgical Sponges , Thoracotomy/methods , Tissue Adhesives/therapeutic use , Tomography, X-Ray ComputedABSTRACT
Severe combined immunodeficiency (SCID) represents a genetically heterogeneous group of primary immunodeficiency disorders. Irrespective of the genetic defect, patients with SCID may be engrafted with transplacentally derived maternal T-lymphocytes that in a subset of cases may be responsive to phytohemagglutinin. Here, we present, from a genetic perspective, an SCID patient who not only harbored a novel mutation in the gene encoding the common gamma chain (gamma c) of the IL-2 receptor (IL2RG), but also carried reactive maternal T lymphocytes that produced a karyotype that was initially perplexing.
