RESUMO
In 2017, the North American Society of Pediatric Gastroenterology, Hepatology and Nutrition published clinical practice guidelines for the assessment and diagnosis of nonalcoholic fatty liver disease (NAFLD). We determined how frequently these investigations suggest an alternate etiology for chronic hepatitis in 8- to 17-year-old patients with body mass index >85%, elevated alanine aminotransferase and radiographic steatosis, and rates of adherence to 2017 guidelines. Methods: We conducted a retrospective chart review of patients presenting to McMaster Children's Hospital from 2017-2020 for evaluation of suspected NAFLD. Bloodwork was reviewed. Results: Ninety-five patients met inclusion criteria. Abnormal bloodwork that required further testing was found in 28.4%; a different chronic liver disease was ultimately diagnosed in 11.6%. Only 9.5% received comprehensive, additional bloodwork for other causes of liver disease. Conclusion: A high proportion of patients evaluated for suspected NAFLD had bloodwork possibly suggesting an alternate diagnosis. Comprehensive testing was infrequently performed. These results reinforce the importance of maintaining a differential diagnosis among children presumed to have NAFLD.
RESUMO
Gastrointestinal basidiobolomycosis (GIB) is unusual, rare, and emerging fungal infection. It is caused by Basidiobolus ranarum. Unlike other fungal infections, B ranarum affects immunocompetent individuals with potentially grave sequelae if unrecognized. GIB is difficult to be diagnosed due to unspecific clinical presentation. Diagnosis of basidiobolomycosis requires culture of B ranarum from tissue. Optimal management of GIB includes antifungal therapy alongside if necessary early surgery.
