Combined Neonatal Alloimmune Neutropenia and Thrombocytopenia in Dizygotic Twins Conceived After Oocyte Donation.

Neonatal alloimmune thrombocytopenia (NAIT) and neonatal alloimmune neutropenia (NAIN) may have severe consequences in the neonatal period. We report two dizygotic twins conceived after donated oocytes, suffering NAIT and NAIN in the context of alloantibodies to human platelet antigens (anti-HPA-5b) and human leukocyte antigens (anti-HLA class I). Genotyping demonstrated paternal homozygosity for HPA-5a, while the neonates were heterozygous for HPA-5b.

Ibuprofen-induced aseptic meningitis: a case report / Meningite asséptica induzida por ibuprofeno: um caso clínico

ABSTRACT Objective: To report a case of a male adolescent with the diagnosis of ibuprofen-induced meningitis. We discuss themain causes of drug-induced aseptic meningitis (DIAM) and highlight the importance of early recognition of DIAM, sothat the offending drug can be withdrawn, and recurrences prevented. Only few DIAM cases have been reported in pediatric age. Case description: A healthy 15-year-old boy presented to the emergency department with headache, nausea, dizziness, fever, conjunctival hyperemia and blurred vision 30 minutes after ibuprofen-intake. During his stay, he developed emesis and neck stiffness. Cerebrospinal fluid analysis excluded infectious causes, and DIAM was considered. He totally recovered after drug withdrawal. Comments: DIAM is a rare entity, that should be considered in the differential diagnosis of an aseptic meningitis. The major causative agents are nonsteroidal anti-inflammatory drugs, particularly ibuprofen. Suspicion is made by the chronologic link between drug intake and the beginning of symptoms, but infectious causes should always be ruled out.

RESUMO Objetivo: Descreve-se o caso de um adolescente do sexo masculino com diagnóstico de meningite asséptica por ibuprofeno. Discutem-se as causas de meningite asséptica induzida por medicamentos (MAIM) e a importância do reconhecimento precoce dessa situação, para que a medicação envolvida seja suspensa e as recorrências prevenidas. Poucos casos foram descritos em idade pediátrica. Descrição do caso: Adolescente de 15 anos, gênero masculino, saudável, procurou o serviço de urgência por cefaleia, náuseas, tonturas, febre, hiperemia conjuntival e visão desfocada 30 minutos após o uso de ibuprofeno. Durante a internação, iniciou vômitos e rigidez na nuca. A análise do líquido cefalorraquidiano excluiu causas infeciosas, e considerou-se como diagnóstico mais provável a MAIM. A recuperação foi total após a suspensão do medicamento. Comentários: A MAIM é rara, mas deve ser considerada no diagnóstico diferencial de meningite asséptica. A principal causa são os anti-inflamatórios não esteroides, principalmente o ibuprofeno. A suspeita clínica é evocada pela relação temporal entre o uso do medicamento e o início dos sintomas, mas as causas infeciosas devem ser sempre excluídas.

IBUPROFEN-INDUCED ASEPTIC MENINGITIS: A CASE REPORT.

OBJECTIVE: To report a case of a male adolescent with the diagnosis of ibuprofen-induced meningitis. We discuss themain causes of drug-induced aseptic meningitis (DIAM) and highlight the importance of early recognition of DIAM, sothat the offending drug can be withdrawn, and recurrences prevented. Only few DIAM cases have been reported in pediatric age. CASE DESCRIPTION: A healthy 15-year-old boy presented to the emergency department with headache, nausea, dizziness, fever, conjunctival hyperemia and blurred vision 30 minutes after ibuprofen-intake. During his stay, he developed emesis and neck stiffness. Cerebrospinal fluid analysis excluded infectious causes, and DIAM was considered. He totally recovered after drug withdrawal. COMMENTS: DIAM is a rare entity, that should be considered in the differential diagnosis of an aseptic meningitis. The major causative agents are nonsteroidal anti-inflammatory drugs, particularly ibuprofen. Suspicion is made by the chronologic link between drug intake and the beginning of symptoms, but infectious causes should always be ruled out.

[Perinatal transmission of hepatitis C virus - Santo André Hospital, Leiria 2002-2006]. / Transmissão perinatal do vírus da hepatite C - Hospital Santo André, Leiria 2002-2006.

BACKGROUND: Vertical transmission of hepatitis C virus (HCV) is the main route of infection in children, occurring in few cases (five percent). Current recommendations for HCV screening include first anti-HCV testing at age > 18 months, reducing false positives and false negatives. Positive results must be confirmed by the presence of HCV RNA on two different occasions. AIMS: To characterize the population of children born to HCV-positive mothers, to identify risk factors for perinatal HCV transmission and to improve the approach to HCV screening. METHODS: The study was conducted in two phases. An analytic retrospective study enrolling children born to HCV-positive mothers between January 2002 and December 2006 was done, followed by a transversal analysis in order to repeat anti-HCV testing, in cases that didn't meet current recommendations for HCV screening and in those without any HCV screening. RESULTS: Fifty-nine children born to HCV-positive mothers in a total of 12 985 births were included, corresponding to a prevalence of 0,45%. A high rate of inadequate pregnancy surveillance, prematurity and low birth weight, mainly in children born to addicted mothers was found. A child with HCV infection without any risk factor for perinatal transmission was found. Among children with negative anti-HCV at age 18 months, half had done anti-HCV prior to nine months of age, all were positive. Children discharged because of negative anti-HCV at nine months of age were called in a second phase of the study, for new anti-HCV at age > 18 months. All were negative. CONCLUSIONS: Perinatal HCV transmission rate was 2,9%. There was no identified risk factor for perinatal transmission in the single case of HCV infection. A high rate of prematurity, low birth weight and inadequate surveillance of pregnancy was found, with statistical significance to relation with mother addiction. Regarding anti-HCV at age < 18 months, a high rate of false positives but no false negative results were found. This study has enabled the detection and correction of mistakes in the approach to HCV screening.