Tumour lysis syndrome as a rare complication of chemotherapy in paediatric Wilms' Tumour: a case report.

Wilms tumour is the most common renal malignancy in children, with two-thirds of cases diagnosed before five years and 95 percent before 10 years of age. Over the last decade, the five-year survival rate has improved dramatically and now approaches 90 %. Tumour lysis syndrome, commonly seen in association with haematological malignancies, is rarely seen in Wilms tumour. We present two cases of Wilms tumour developing tumour lysis syndrome in the first week of initiation of chemotherapy. Both patients presented with huge abdominal masses causing mass effect on surrounding structures. Chemotherapy was administered as per International Society of Pediatric Oncology guidelines (SIOP). Both patients developed laboratory and clinical tumour lysis syndrome (TLS) after the first cycle of chemotherapy requiring continuous renal replacement therapy (CRRT). However, both died because of multiorgan failure.

Tuberculous Dactylitis with Concomitant Thyroid Involvement: A Rare Presentation of Childhood Tuberculosis.

Extrapulmonary tuberculosis rarely presents as thyroid involvement along with other manifestations, and poses a diagnostic challenge on account of paucibacillary nature of disease. In general, the diagnosis of tuberculosis is based on epidemiological risk factors, clinical features, imaging studies, in addition to a positive skin testing or Interferon Gamma Release Assay (IGRA). A 14-year boy presented with history of fever and weight loss for one year. On examination, he had painful swelling of fingers and toes along with a painless thyroid nodule and squint. Hand X-ray showed lytic-sclerotic lesions in phalanges. MRI of brian showed multiple ring enhancing lesions and radionuclide thyroid scan showed multinodular goitre. Histology showed epithelioid cell granulomas (thyroid and bone) and tuberculomas of brain confirmed tuberculosis. He responded well to four-drug anti-tuberculous therapy and his fever, squint, thyroid nodule, and dactylitis disappeared. Tuberculosis of thyroid, a rare phenomenon, can be diagnosed and treated well; if clinical index of suspicion is kept high, particularly in tuberculosis prevalent areas.

Psittacosis: Rare Respiratory Problem in Children.

Psittacosis is a rare disease particularly in children with usual presentation of respiratory and constitutional symptoms. The cases may remain undiagnosed or diagnosis may be delayed because of lack of awareness among the paediatricians and physicians. Early diagnosis is very important as this is potentially curable and preventable disease. An interesting case of psittacosis is being reported here, which has been treated successfully with azithromycin.

Vitamin D levels in children with growing pains.

OBJECTIVE: To estimate the serum levels of vitamin D in children with growing pains and determine the relationship between serum vitamin D levels, parathormone and routine biochemical markers. STUDY DESIGN: Cross-sectional study. PLACE AND DURATION OF STUDY: Department of Paediatrics, Liaquat National Hospital, Karachi, from October 2008 to September 2009. METHODOLOGY: Hundred children, aged 5-12 years presenting in Paediatric Outpatient Department of Liaquat National Hospital, Karachi, with limb pains, fulfilling the diagnostic criteria of growing pains, were included. Children with any systemic illness, organic cause of pain, rheumatologic disorders and signs of rickets were excluded from the study. Children were investigated for serum total calcium, inorganic phosphorus, alkaline phosphatase, vitamin D3 (25-hydroxecholecalciferol) and parathormone levels. On the basis of serum vitamin D3 level, patients were divided into 3 groups; group 1 with normal level of vitamin D3 (> 75 nmol/L), group 2 with vitamin D insufficiency (level between 50-75 nmol/L), and group 3 with vitamin D deficiency (level < 50 nmol/L). Significance of group proportions was determined using chi-square test with significance at p < 0.05. RESULTS: The mean age of the participants was 8.05 years with the majority (59%) being females. Only 6% had normal vitamin D levels. Over 95% of the children with vitamin D insufficiency had normal alkaline phosphatase and parathormone levels. CONCLUSION: Hypovitaminosis D may have a role in pathogenesis of growing pains. All children with unexplained limb pains without identifiable organic pathology should be tested for vitamin D status, and treated, if necessary. Routine biochemical markers alone are not sufficient to detect all cases of hypovitaminosis D.