A Comparative Study Between Cytomegalovirus Immunoglobulin M-Positive and CMV Immunoglobulin M-Negative Biliary Atresia in Infants Attending a Tertiary Care Hospital in Bangladesh.

Purpose: Perinatal cytomegalovirus (CMV) infection can lead to biliary atresia (BA) in different entities. This study aimed to compare the clinical, hematological, biochemical, and histological features of infants with BA based on their CMV immunoglobulin M (IgM) status at presentation. Methods: This cross-sectional descriptive study was carried out between January 2019 and June 2020 at the Department of Pediatric Gastroenterology and Nutrition at the Bangabandhu Sheikh Mujib Medical University (BSMMU) in Dhaka. Forty-three patients with BA were selected purposively and categorized into either the CMV IgM-positive or CMV IgM-negative BA group. Categorical variables were compared using Fisher's exact test and chi-square tests, while the Student's t-test and Mann-Whitney U-test were used to compare continuous variables. For all statistical tests, a p-value <0.05 was considered statistically significant. Results: Thirty-three (76.7%) of the cases were between 2 and 3 months of age on admission. The clinical, hematological, and biochemical parameters did not differ significantly between the CMV IgM-positive and CMV IgM-negative BA groups. Most (50.0%) of the CMV IgM-positive cases had fibrosis stage F2, while 43.5% of the CMV IgM-negative cases had fibrosis stage F3, with no significant difference between the groups (p=0.391). Conclusion: Our data shows no significant distinction between CMV IgM-positive and CMV IgM-negative BA, suggesting that CMV does not contribute to BA pathogenesis.

Hepatic Histoplasmosis: An Update.

Histoplasma capsulatum is the most common cause of endemic mycosis in developing countries. It is a self-limited and asymptomatic disease in immunocompetent individuals but remains a frequent cause of opportunistic infection in patients with compromised immune status. Liver involvement as a part of disseminated histoplasmosis is well known. However, liver infection as a primary manifestation of histoplasmosis without evidence of primary lung involvement is rare. In conclusion, clinicians should be aware of isolated histoplasmosis affecting the hepatobiliary system, and careful evaluation is warranted to confirm the diagnosis. Given the appropriate clinical context, histoplasmosis should be considered in both immunocompetent and immunocompromised patients, regardless of pulmonary symptoms, in non endemic as well as endemic areas.

Omental Cyst - Rare Cause of Abdominal Pain in a 7-Year-Old Child: A Case Report.

INTRODUCTION: Abdominal pain is a common complaint in children. In most cases it may be functional. Among all organic causes, an abdominal cyst of omental or mesenteric origin is an uncommon etiology. CASE PRESENTATION: A 7-year-old girl presented with a short history of abdominal pain for 1 month associated with gradual abdominal distention. Physical examination revealed a large oval palpable firm, non-tender mass extending almost the whole abdomen. Imaging studies were suggestive of an intra-abdominal cyst, and the diagnosis was confirmed after exploratory laparotomy. The patient was managed surgically by enucleation of the cyst. CONCLUSION: Omental cysts are a rare benign condition, but should be considered as a diagnostic hypothesis in children with abdominal pain with or without a mass. It is difficult to diagnose an omental/mesenteric cyst clinically. A proper imaging study can guide the diagnosis. After confirming the diagnosis, the main treatment would be surgical excision.

INTRODUÇÃO: A dor abdominal é um sintoma comum durante a infância, mas na maioria dos casos é funcional. Entre as causas orgânicas potenciais, os quistos abdominais de origem epiplóica ou mesentérica são raros. CASO CLÍNICO: Uma menina de 7 anos de idade desenvolveu um quadro clínico caracterizado por dor e distensão abdominal gradual, com aproximadamente 1 mês de evolução. O exame objetivo revelou uma massa abdominal oval, de grandes dimensões, de consistência firme, mas indolor. Os estudos imagiológicos sugeriram a presença de um quisto intra-abdominal que se confirmou durante uma laparotomia exploradora. O tratamento foi cirúrgico e consistiu na enucleação do quisto. CONCLUSÕES: Os quistos epiplóicos são uma condição benigna rara, mas devem ser considerados no diagnóstico diferencial em crianças com dor abdominal, independentemente da presença de uma massa. O diagnóstico semiológico é difícil, mas um estudo imagiológico adequado pode ser esclarecedor. Após confirmação do diagnóstico a excisão cirúrgica é a modalidade terapêutica de eleição.

Rhabdomyosarcoma of the common bile duct mimicking choledochal cyst: a rare cause of obstructive jaundice / 中国当代儿科杂志

Extrahepatic biliary tract tumors are rare and among them rhabdomyosarcoma is most common. Rhabdomyosarcoma is a soft tissue malignant musculoskeletal tumor and is a very rare malignancy of the common bile duct in children. It usually presents as obstructive jaundice and/or pruritus. If there is no local invasion to the adjacent tissues, the radiological appearance of the tumor lesion is like a choledochal cyst. So the diagnosis is usually made at surgery or by preoperative biopsy. It is important to diagnose early and differentiate it from choledochal cyst and start treatment as early as possible for long time survival of the patient. This case report presented a case of a 10-year-old boy with recurrent onset of obstructive jaundice and fever preoperatively who was diagnosed as choledochal cyst and postoperatively as embryonal rhabdomyosarcoma of the common bile duct. After surgical resection and postoperative chemotherapy, the child had a good prognosis. So it is crucial to know that this rare tumor can mimic congenital choledochal cyst and it should be considered in the differential diagnosis of obstructive jaundice in children.