Loss of consciousness in a child due to loperamide]

Loperamide is an antidiarrheal peripheral opiate agonist, with rare neurological secondary effects. We report the case of a 26-month-old child who had impaired consciousness under treatment by loperamide, and was treated successfully with naloxone. Limitations of the use of loperamide in young children are underlined. Naloxone may be used in case of impaired consciousness, for a diagnostic as well as therapeutic purpose.     

Hypokalemic rhabdomyolysis in a child due to amphotericin B therapy

Hypokalemia can result in life-threatening complications if not treated appropriately. Although hypokalemia is a frequent adverse effect of amphotericin B therapy, there are no reports in the pediatric literature on hypokalemia-associated rhabdomyolysis induced by this drug. A ten-year-old boy with a history of one week amphotericin B treatment was admitted with weakness of the lower extremities, inability to walk and calf pain. Laboratory tests showed a serum potassium of 1.7 mEq/L and a serum creatinine phosphokinase of 3937 U/L plus myoglobulinuria. Following fluid expansion and intravenous potassium replacement, the patient progressed to achieve full regression of muscular weakness after one week. This report highlights hypokalemia as a rare cause of rhabdomyolysis. Patients on amphotericin B should be checked for this rare yet potentially life-threatening complication.     

Severe asthma due to an esophageal foreign body in a child]

A 4-year-old boy had infantile bronchial asthma resistant to treatment. He was referred for a febrile respiratory distress which led to the diagnosis of periesophagus mediastinis mass with erosion of both contiguous vertebral discs. The oesophagogram showed a foreign body in an esophageal diverticulum. After its extraction, all pulmonary symptoms disappeared.     

Obstructive hydrocephalus due to a third ventricular neuroepithelial cyst

Cysts occupying the third ventricle are rare lesions and may appear as an unusual cause of obstructive hydrocephalus. Various types of lesions occur in this location, and they generally have an arachnoidal, endodermal, or neuroepithelial origin. The authors present a case of acute hydrocephalus following minor trauma in a child due to cerebrospinal fluid outflow obstruction by a third ventricular cyst. Definitive diagnosis of this cystic lesion was possible only with contrast ventriculography and not routine computed tomography or magnetic resonance imaging. The investigation, treatment, and pathological findings are discussed.     

Acute hydrocephalus due to Candida meningitis in a 2-month-old infant

A case of triventricular acute hydrocephalus is reported in a 2 month-old male. The etiology was a Candida sepsis with neonatal onset and subacute course of meningitis and arthritis. No immune deficiency was detected and antibiotic treatment appeared to be the only predisposing factor to systemic candidiasis in this neonate. The condition was treated successfully with amphotericin B, fluocytosin and ketoconazole. At follow up, 17 months later, the development of the child appeared normal.     

Disseminated nocardiosis in a child with acute lymphoblastic leukemia]

Nocardiosis is a rare infectious disease in children. We report here a disseminated nocardiosis in a child with acute lymphoblastic leukemia. The patient presented prolonged febrile neutropenia and nodular pneumopathy. Based on the amplification of a 16S rDNA, a PCR assay detected Nocardia sp. in the patient's bronchoalveolar lavage (BAL) fluid. Culture of BAL samples yielded Nocardia nova colonies after 2 weeks of incubation. Hepatic, splenic, renal and cerebral localisations were detected on extension checkup. trimethoprime-sulfamethoxazole and amikacine were started given the results of PCR assay, with a good response. Improvement of the patient's general condition led to complete chemotherapy under ciprofloxacine and ceftriaxone treatment, without nocardiosis reactivation. Nocardiosis is a rare complication in children with acute lymphoblastic leukemia. trimethoprime-sulfamethoxazole prophylaxis is widely used to prevent Pneumocystis jiroveci infection in children with haematologic malignancies. As Nocardia species are usually sensible, trimethoprime-sulfamethoxazole could play a role in Nocardia prophylaxis in such population. In our patient, compliance with trimethoprime-sulfamethoxazole had been low. Nocardia species are relatively fastidious growth bacteria and are difficult to isolate with classical bacteriological techniques. Molecular methods are now available, with a good sensitivity and fast results allowing to start an appropriate antibiotherapy before culture results, as early treatment is a major prognosis factor in nocardiosis. Nocardia infection should be suspected in case of nodular pneumopathy in immunocompromised children. An extension checkup should be performed to detect secondary localisations.     

Steroid therapy for asthma in children

PURPOSE OF REVIEW: To highlight studies that have contributed significantly to our current knowledge of inhaled glucocorticoids in childhood asthma. RECENT FINDINGS: In 2006, three important studies were published that investigated whether inhaled glucocorticoid therapy, if started soon after the onset of asthma symptoms, could alter the subsequent course of the disease. Several studies focused on the comparative clinical efficacy of inhaled glucocorticoids to leukotriene receptor antagonists in children with mild to moderate asthma. Although the Expert Panel had recommended inhaled glucocorticoid therapy as the preferred long-term controller with persistent asthma, there were no specific studies comparing these two classes of long-term controller medications in children. Another topic of significant clinical interest was the comparative efficacy of inhaled glucocorticoid to systemic glucocorticoids in the treatment of acute asthma. The question was answered in a study published in children with mild to moderate acute asthma. Lastly, the safety of inhaled glucocorticoid therapy was also evaluated in preschool children. SUMMARY: Inhaled glucocorticoids are the preferred long-term controller for initiating treatment of persistent asthma. Early intervention with inhaled glucocorticoids achieves symptom control but does not alter the natural history of asthma. Inhaled glucocorticoids are not as effective as systemic glucocorticoids for managing acute asthma exacerbations.