Unusual presentation of infantile hemangioendothelioma

Infantile hemangioendothelioma is a rare benign hepatic tumor arising from mesenchymal tissue. Most of the cases present with congestive heart failure and asymptomatic abdominal mass were before 6 months of age. We described a patient with projectile vomiting, which is quite an unusual presentation. Following surgical resection, neither recurrence nor symptoms were seen in 2 years of follow-up.     

Unusual presentation of congenital syphilis

Congenital syphilis (CS) usually presents in the neonatal period and may involve any organ system. The signs are diverse and a high index of suspicion must be maintained to make the diagnosis. Early congenital syphilis can present at any time before 2 years of age, but a review of the literature over the last 30 years indicates that it usually presents in the neonatal period and seldom later than 3-4 months of life. We report an 8-month-old boy who presented an unusual combination of signs of congenital syphilis, which led to delay in establishing the diagnosis. This case emphasises the importance of maintaining a high index of suspicion for CS throughout early childhood.     

Unusual CNS presentation of neuroblastoma

Neuroblastoma is a common tumor of childhood, usually occurring in children under 4 years of age [1]. We report a case of a 10-year old child who initially presented with a large calvarial mass representing a solitary site of metastasis from an occult adrenal neuroblastoma. The sunburst pattern of the calvarial metastasis noted in this case is rarely seen with neuroblastoma. The age of our patient, solitary focus of metastasis at presentation, and imaging appearance of the tumor are very uncommon findings of neuroblastoma.     

Unusual radiographic presentation of IgA nephropathy

An adolescent male presented with hematuria and flank pain. Transient focal renal parenchymal defects were demonstrated by ultrasonography, radionuclide scintigraphy and computed tomography. Renal biopsy revealed IgA nephropathy with acute tubular necrosis. This peculiar radiographic pattern has not, to our knowledge, been previously described in IgA nephropathy and may relate to tubule cell damage by red blood cell casts or patchy renal ischemia.     

Unusual presentation of metastatic mediastinal melanoma

An 11-year-old boy with an unresectable mediastinal stage 3 malignant melanoma and undocumented primary lesion is presented. Despite aggressive chemotherapy and 90% tumour resection, he died of his disease. Although rare, metastatic melanoma must be considered in the diagnosis of any mediastinal lesion and appropriate histological examinations, including electron microscopy, performed. Histological examination of all excised tissue should be routine. The prognosis is grave, but aggressive surgery in combination with appropriate chemotherapy may be curative in a small number of patients.     

Unusual presentation of a retroperitoneal lymphangioma

A 3 year old child presented with hemorrhagic ascites of short duration. Based on clinical manifestation and investigations a differential diagnosis of peritoneal tuberculosis, pancreatic ascites or malignant ascites was considered. Laparotomy revealed a huge retroperitoneal cystic lymphangioma confirmed by histopathology. The unusual presentation of retroperitoneal tumours as pseudoascites is discussed.     

Nephrocalcinosis due to vitamin D intoxication

Two cases of vitamin D intoxication are presented. The patients, one aged three months, and the other aged four months, were given Vit D in doses ranging from 30,000 IU/day to 60,000 IU/day for over a period of from one to three months. Laboratory data showed serum calcium levels of 17.6-19.5 mg/dl and phosphorus levels of 2.6-3.2 mg/dl. Renal ultrasonographic examination demonstrated medullary nephrocalcinosis in both patients. In this study the clinical, biochemical and ultrasonographic findings and the therapy of Vit D intoxication are reviewed, and preventive measures are suggested.     

Unusual presentation of perforation of the gallbladder

Perforation of the gallbladder is a known sequela of acalculus cholecystitis or trauma. A perforated gallbladder may be acute or chronic and can present with vague symptoms making the diagnosis difficult. With delayed recognition there is increased morbidity and mortality. The preoperative diagnosis requires an awareness of the symptoms and signs of acalculus cholecystitis as well as factors that predispose to the development of the diseased gallbladder. Awareness of the radiographic findings associated with a perforated gallbladder and acalculus cholecystitis is also important. The following is a case report of a child with a perforated gallbladder wity a radiographic presentation not previously described. A review of the clinical pathogenesis and reported radiographic findings is also included.     

Clinical presentation of intoxication due to synthetic cannabinoids

Synthetic cannabinoids are relatively novel substances of abuse. The use of these compounds among adolescents and young adults has been increasing, making it important for pediatric providers to be familiar with the presenting signs and symptoms of intoxication. We describe three case presentations of reported synthetic cannabinoid intoxication and provide a brief discussion of these compounds.     

Unusual presentation of childhood Systemic Lupus Erythematosus

Bullous systemic lupus erythematosus is a rare blistering condition with a distinctive combination of clinical, histological and immunopathologic features that together constitute a unique bullous disease phenotype. It is often associated with autoimmunity to type VII collagen. Here we report a child who presented with bullous systemic lupus erythematosus. Rapid resolution of the blisters occurred following treatment with dapsone.