Acute osteomyelitis as a complication of varicella.

Varicella is a common viral infection in childhood, and acute osteomyelitis is one of the rare but serious complications. We report two cases of osteomyelitis as a complication of varicella. The possibilities and limitations of the different imaging modalities are discussed, as well as imaging findings during the course of this condition.

Immune thrombocytopenic purpura in childhood in Norway: a prospective, population-based registration.

A prospective, population-based registration of children with immune thrombocytopenic purpura (ITP) was performed in Norway in 1996 and 1997. Ninety-two cases were identified, indicating an incidence of 5.3 per 100,000 children under 15 years. The sex ratio (female/male) was 1.2/1. Fifty-six percent presented with cutaneous signs only. The lowest platelet count was < 20 x 10(9)/L in 91%. In spite of mild bleeding symptoms, medical treatment was given in 68%, in most cases (57/63) with intravenous immunoglobulin. A total of 41/44 patients with platelet counts of < or = 5 x 10(9)/L were treated, regardless of whether they had mucous bleedings or not. Eighteen percent had platelet counts < 150 x 10(9)/L at 6 months, and 9% at 12 months following diagnosis. One patient with therapy-resistant chronic ITP died 16 months after diagnosis from an anesthesia complication related to profound epistaxis. This study shows a relatively high incidence. As in other studies, there was a tendency to treat platelet counts rather than bleeding symptoms.

Multiple intestinal atresias in two brothers.

Two brothers with multiple intestinal atresias, from jejunum to rectum, are reported. This syndrome with multiple atresias in small and large bowel and intestinal calcification is an entity of probably autosomal recessive inheritance.

An infant with thanatophoric dwarfism surviving 169 days.

A female infant with thanatophoric dwarfism surviving 169 days is described. The genetics of the entity are briefly discussed.

Paroxysmal cold haemoglobinuria. The most frequent acute autoimmune haemolytic anaemia in children?

Paroxysmal cold haemoglobinuria (PCH) is a disease which today is met mainly in its acute form in children. The diagnosis is revealed by a careful serological examination. Case reports of four children with PCH are given in this paper. They all showed typical clinical pictures of PCH, and displayed the expected serological findings, including a bithermic autoantibody (haemolysin), the Donath-Landsteiner antibody. Children with PCH often require immediate transfusion therapy, but certain precautions should be taken regarding transfusion policy in these patients. When the acute phase is overcome, the prognosis is excellent.

Immunoblastic lymphadenopathy with early onset in two boys: immunohistochemical study and indication of decreased proportion of circulating T-helper cells.

Two boys, 5 and 18 years old, had had frequent infections from their second month of life and had later suffered from generalized lymphadenopathy, intermittent maculopapular exanthema, anaemia, and weight loss. Histopathological features of lymph nodes were consistent with immunoblastic lymphadenopathy. Immunohistochemistry showed hyperimmune state with numerous T cells and macrophages along with selective polyclonal IgM-producing cell response in one patient, and IgG- and IgM-producing cells in the other. Both had severe deficiency of serum IgA. Classification of T-cell subsets (OKT4+ and OKT8+) in peripheral blood indicated an imbalance with a relative excess of putative suppressor cells (OKT4+/OKT8+ less than 1; normal, 1.7). It is suggested that decreased T-helper cell activity may explain the observed maturational defects in the B-cell system which probably underlie a hyper-reactive state induced by some sort of triggering, e.g. chronic infection. During steroid treatment the general condition improved remarkably and the lymphadenopathy and hepatosplenomegaly decreased, but the T-cell subset proportions and the serum immunoglobulin levels remained unchanged.

Mumps meningitis: prolonged pleocytosis and occurrence of mumps virus-specific oligoclonal IgG in the cerebrospinal fluid.

A pleocytosis of the CSF occurred in all of 10 children with mumps meningitis and persisted for weeks and months in some patients. Oligoclonal IgG proteins were detected in the cerebrospinal fluid (CSF) during the 2nd week after onset of meningitis or later in 4 out of 10 patients, and could be detected as late as 11 and 12 months after meningitis in 2 patients. Evidence is presented that the oligoclonal IgG represents mumps virus-specific antibody synthesized locally in the brain. Oligoclonal virus antibodies were demonstrated also in serum samples. The persistence for weeks and moths of pleocytosis and oligoclonal IgG virus antibody in the CSF may imply that a virus infection in some cases persists in the brain in spite of apparently complete clinical recovery.