Hypereosinophilia and recurrent angioneurotic edema in a 2 1/2-year-old girl

A 2 1/2-year-old girl presented with monthly episodes of angioneurotic edema, eruption of pruritic papules, and fever. During acute episodes, white blood cell counts rose as high as 52,100/cu mm with 62% eosinophils, and body weights increased up to 20% of remission weight. Short courses of prednisone acetate caused rapid defervescence, resolution of angioneurotic edema, and lowering of eosinophil counts. In a one-year follow-up no evidence was found for cardiac or other visceral organ involvement. Findings of extensive diagnostic evaluations revealed no evidence for atopy, neoplasm, collagen-vascular disease, or parasitic infestation. Results of immunologic studies were essentially normal with the exception that this patient had a high level of circulating activated helper T cells. Biopsy specimens of the skin lesions revealed dermal infiltration of lymphocytes and eosinophils with deposition of eosinophil major basic protein in the extracellular matrix. Awareness of this clinical entity and its distinction from the hypereosinophilic syndrome is important because of its favorable prognosis and rapid response to corticosteroid therapy.     

Successful acute and long-term treatment of renin-induced hypertension in two infants with captopril

Captopril, an orally active inhibitor of angiotensin-converting-enzyme, offers a new approach in the treatment of renin-induced hypertension, which is refractory to conventional drugs. A 4 months old infant developed after nephrectomy again hypertension which was probably renin-induced. BP did not respond to high doses of methyl-dopa, clonidine, hydralazine, and furosemide. An acute BP response to captopril was seen at a daily dose of 150 mg. During long-term treatment, 75 mg captopril and 12.5 mg hydrochlorothiazide resulted in normalization of BP. In a second child with renin-induced hypertension since the firth month of life, treatment wiht hydralazine, clonidine and hydrochlorothiazide was in part effective, but failure to thrive was progressive. Captopril treatment was started at the age of 20 months. BP was lowered at a daily dose of 75 mg and normalized during long-term therapy with 50 mg. Side effects were not seen.     

Intracranial pressure increase following treatment nalidixic acid in a child aged 3 1/2 years (author's transl)

Neurological symptoms developed in a girl aged three-and-a-half years during treatment with nalidixic acid. The symptoms progressed even after the preparation had been discontinued, and culminated in the development of a transient intracranial pressure increase.     

Variable immunologic deficiency syndrome in a 10 1/2-year-old girl with Haemophilus meningitis

A 10 1/2-year-old girl with Haemophilus-meningitis was found to have hypogammaglobulinemia. Further immunologic evaluation revealed common variable immunodeficiency. Patients suffering from severe or recurrent infections should always be suspected to have immunodeficiency disease.     

Thyroxine treatment in acute renal failure (author's transl)]

8 patients suffering from acute renal failure (shock kidney) with anuria extending over 3 to 5 days, were treated with L-thyroxine for 5 to 9 days (5-6 mug per kg body weight per day orally). Diuresis was restored within 34 to 46 hrs. Plasma levels of urea and creatinine decreased earlier and much more rapidly to normal than was to be expected from the natural history of the disease, indicating the prompt and extensive increase of glomerular filtration rate. Polyuria seemed less pronounced and also shortened as compared with the ordinary course of that form of sudden renal insufficiency. Obviously, the well-known diuretic response in the normal individual to high doses of thyroid hormones in not a factor in the induction of diuresis in acute renal failure. The tendency with L-thyroxine treatment to dilate the preglomerular arterial vessel is considered a consequence of the stimulation of sodium reabsorption in the upper nephron. High values of RPF and GFR, regularly observed in hyperthyroidism or after L-thyroxine administration, do not depend on any augmentation of cardiac output or on arterial hypertension, since such symptoms were missed in our patients and, in our view, such an interpretation is excluded by the very existence of the so-called autoregulation of the kidney which leaves RPF (and therefore GFR) independent of systemic blood pressure. The same intrarenal feed-back mechanism, normally adapting the glomerular blood supply to the resorptive capacity of the proximal-tubular epithelium (mediation via the juxta-glomerular apparatus), is responsible for the GFR- and RPF-raising effect of exogenous L-thyroxine in the intact kidney as well as in acute renal failure: both sodium reabsorption and sodium filtration are accelerated.--The special conditions under which L-thyroxine interferes with the pathogenetic process of acute renal failure, the latter being characterised by the critical insufficiency of tubular sodium reabsorption and therefore by preglomerular arterial constriction, is discussed on the basis of a new hypothesis concerning the thyrogenic nephrotropic effects in general.     

Visceral leishmaniasis (Kala-Azar) in a 3-year-old German infant (author's transl)]

The article reports on a case of visceral leishmaniasis in a 3-year-old child of German residents in Rome who had passed two vacations on the isle of Ischia. Initial signs were intermittent temperatures, marked anorexia, hepatosplenomegaly and pancytopenia, with spontaneous recovery after three weeks. At that time, leishmania serology was already positive, whereas no leishmania were found in several bone marrow preparations despite a most thorough search. During the following eight weeks, the patient had chickenpox and mumps. During the mumps, relapse of the visceral leishmaniasis occurred, associated with a dramatic increase of the hepatosplenomegaly and recurring pancytopenia. It was only now that we could discover multiple leishmania infection of the bone marrow. Subsequent therapy with sodium stibogluconate (Pentostam) was effective without any complications, and eventually cured the patient.     

Spinal epidural abscess in an 11-year-old boy (author's transl)

Spinal epidural abscesses can occur in childhood. Neurological defects are late manifestations in the course of this disease. Recognition of the early symptoms followed by immediate neurosurgical intervention can prevent these defects. This report describes the course of an epidural abscess in an 11 year old boy. The painful febrile spinal syndrome of the cervical column was the outpointing initial symptom. Lateron disturbances of the autonomic nerve function appeared, such as acute abdomen. The differential diagnosis of the early symptoms is discussed.