What's your diagnosis?: Herpes simplex infection mimicking recurrent acute flares in systemic lupus erythematosus: A case report with review of literature

It is well known that there is an increased risk of infections in SLE patients on immunosuppression. These infections may mimic lupus flares with similar manifestations such as fever, oral ulcers, leukopenia/pancytopenia, renal involvement, pneumonitis, lymphadenopathy and others. The management of SLE in these two situations becomes contrasting. Viral infections are an important cause of morbidity and mortality in SLE patients but are often not suspected or investigated for. Herein, we present a case of SLE on immunosuppression who had recurrent herpes simplex infection, mimicking flares of the disease. The case highlights that one should have a high index of suspicion along with appropriate laboratory back up to diagnose these infections.     

Evaluation of congenital diaphragmatic hernia in a tertiary health center of a developing country: management and survival

Aim The purpose was to evaluate the diagnosis and efficacy of management of congenital diaphragmatic hernia (CDH) in a tertiary health center of a developing country. Methods Forty-six children aged from 1 day to 7 years were studied. Parameters studied were age, sex, clinical features, and management. Results Fifty-six percent of patients presented in the neonatal period; however, none of them presented on the first day of life. The majority (91.3%) of patients had left-sided CDH. Respiratory distress was the most common clinical feature observed (91.3%). Chest X-ray confirmed the diagnosis in 82.6% of patients, and contrast study was needed in the remaining 17.4%. The survival rate was 87%. It was better in patients presenting late than those presenting in the early neonatal period. Stabilization in the preoperative period improved survival. Not using a chest tube had no adverse effect on survival. Conclusion The relatively increased survival rate of CDH in a tertiary health center of a developing country is attributed to delayed arrival to the center. Respiratory infections compound the survival. More studies are needed before it can be safely said that not using a chest tube has no adverse outcome. Late presentation has been associated with varied manifestations, hence proper clinical evaluation, a high index of suspicion and adequate management, which includes imaging and surgery after stabilization, gives excellent results.     

Paediatric gastric teratoma.

AIM: This paper reviews our experience with patients presenting with gastric teratoma treated over an eighteen-year period. This rare paediatric tumour has an excellent prognosis after curative resection. METHODS: There were seven patients, all males. Investigations included a haematological profile, plain radiography and ultrasound of the abdomen. All patients were operated and the specimens subjected to histopathological examination. RESULTS: The age at presentation ranged from 1 month to 7 years. Two patients presented with melaena and the rest with progressively increasing abdominal mass. Our oldest patient had a massive tumour occupying nearly the whole abdomen. None of the children had metastases and none of the lesions had invaded adjacent structures. The tumours could be completely resected and all patients had an uneventful recovery. Histology of the tumours showed mature elements arising from the three germ layers in 6 children, one child had an immature teratoma. The average follow-up was 3 years (range 2 - 6 years). None of the patients has had a recurrence or any other problem. CONCLUSIONS: Gastric teratoma is a rare tumour but amenable to curative resection with an excellent prognosis.     

Septic meningitis

Summary An analysis of 50 children with pyogenic meningitis is presented. Bacteria were grown in 28, the common ones being pneumococcus, staphylococcus, and pseudomonas. The influence of previous antibacterial therapy on the clinical features and investigations is stressed. The mortality was 30% and four children developed sequelae. From the departments of Pediatrics and Pathology K. G. Medical College, Lucknow.     

Middle cerebral occlusion in young children

Summary Two cases of acute hemiplegia of apparently obscure aetiology showing middle cerebral artery occlusio, flat presented. Arteritis is suggested as a cause of occlusion. The literature is discussed.