Tuberculous mediastinal mass presenting with stridor in a 3-month-old child

A 3-month-old boy with a history of intermittent stridor was found to have obstructive emphysema on chest x-ray. Further investigations found a mediastinal mass compressing the carina and left mainstem bronchus. The mass was excised and found to be of tuberculous origin.     

Xanthogranulomatous pyelonephritis presenting as a pseudotumor in a 2-month-old boy

The authors report on a 2-month-old boy presenting with a right renal mass. Investigations including ultrasound scan and computed tomogram were suggestive of a renal tumor. A right nephrectomy was performed with great difficulty because of dense adhesions to the adjacent structures. Cut section of the specimen showed the entire kidney to be replaced by cheesy-yellow areas. Histological examination was suggestive of xanthogranulomatous pyelonephritis. Although rare at this age, xanthogranulomatous pyelonephritis should be considered in the differential diagnosis of a renal mass in children. The lesion is unique among the inflammatory conditions in closely mimicking renal tumours clinically. A thorough histological examination also is suggested because the features can get confused easily with those of renal tumors.     

Xanthogranulomatous pyelonephritis in a renal allograft

We report a case of xanthogranulomatous pyelonephritis in a cadaver kidney allograft. The patient had diabetic glomerulosclerosis. The predisposing factors that led to this condition included hyperglycemia, a previous rejection reaction and Escherichia coli urinary infection. Persistent fever, pyuria, bacilluria and a nonfunctioning allograft resulted in allograft nephrectomy. The diagnosis was made on histological examination. Diagnostic criteria for xanthogranulomatous pyelonephritis in the allografted kidney are similar to those in the native kidney.     

Xanthogranulomatous pyelonephritis in renal transplant recipient

Xanthogranulomatous pyelonephritis is reported in the native kidney of a renal allograft recipient. Immunoglobulin deposition in the transplant kidney in the absence of cell-mediated rejection, accompanied by selective cultures showing Escherichia coli from the native kidney, led to the diagnosis. Native nephrectomy resulted in resolution of the patient's chronic bacteriuria and creatinine elevation.     

Thyroid abscess in a 14-month-old child

Suppurative thyroiditis occurring in childhood is rare. Progression to abscess formation is an even more uncommon occurrence. Only four thyroid abscesses occurring in children under 15 yr of age have been reported in the past 20 yr.^1–4A 14-mo-old white girl developed an enlarging mass in the anterior neck. Two weeks previously she was treated for otitis media by her local physician and subsequently was observed to develop a mass in the area of the thyroid gland. Her febrile course was not altered by antibiotics. Physical examination was entirely within normal limits except for the thyroid which was firm and hard with a 4-cm movable mass in the region of the left lobe of the thyroid. There was no associated erythema or apparent tenderness.Laboratory studies included a hemoglogin of 11.6 g/100 ml, hematocrit of 33.5 vol %, white blood cell count of 16,700/ml³ with a differential count of 65 neutrophils, 30 lymphocytes, and 5 monocytes. A urinalysis revealed no abnormalities. Stool culture grew normal enteric flora. A throat culture grew non-Group A beta hemolytic streptococci. A chest film revealed no abnormalities. Studies of thyroid function included a T-3 (30.4%) within normal limits and a T-4 (10.1 μg) in the high euthyroid range.The child received erythromycin 125 mg orally at 6-hr intervals without cessation of fever for 4 days. At this time, it was felt that the fever was related to the thyroid mass which appeared unchanged from the time of admission.At operation, an abscess cavity was noted in the superion of the left lobe of the thyroid gland. Approximately 10 cc of purulent material was removed from the cavity and a Penrose drain was placed in the abscess cavity. A biopsy specimen revealed inflammation and fibrosis consistent with the wall of the abscess. Bacterial, fungal, and acid-fast cultures of the pus were negative.The child became afebrile within 24 hr after operation. The postoperative course was uncomplicated except for the occurrence of a skin abscess at the site of the operative incision. Drainage of this abscess yielded 4 cc of purulent material from which staphylococcus epidermidis was grown. Subsequently the child has not experienced any further difficulty and remains euthyroid.     

Xanthogranulomatous pyelonephritis with associated renal cell carcinoma

A case of xanthogranulomatous pyelonephritis with an associated granular type of renal cell carcinoma is presented.     

Acute quadriplegic myopathy in a 16-month-old child

We present a case of a 16-month old previously healthy child who was hospitalized because of an acute respiratory insufficiency most likely caused by a viral infection and who then developed a severe acute quadriplegic myopathy (AQM). Initial clinical symptoms were respiratory acidosis, dypnea, intense wheezing, and deterioration of the level of consciousness, which required orotracheal intubation and mechanical ventilation. We administered neuromuscular blocking agents, corticosteroids, and antibiotics. After 9 days the clinical picture improved. An attempt to wean from the ventilator failed. We diagnosed AQM. This paper discusses AQM and its clinical importance.     

Traumatic hip dislocation in a 21-month-old child

Traumatic hip dislocation in the paediatric population is a relatively rare occurrence and constitutes an orthopaedic emergency. A trivial force is all that is required and non-accidental injury should not be necessarily suspected. A case report involving a hip dislocation in a 21-month-old child, the youngest in the recent English literature is detailed.     

True aneurysm formation in a 6-month-old child

A patient had a true aneurysm of the left iliac artery, first noted at 6 months of age. The aorta was normal and no septic course could be documented. Furthermore, the umbilical artery catheter tip did not lie in the vicinity of the aneurysm. To our knowledge, this is a heretofore unreported event.     

Coccidioides immitis osteomyelitis in a 12-month-old child

The case of a 12-month-old Mexican-American boy with Coccidioides immitis osteomyelitis of the little finger metacarpal and os calcis is presented in which a "cure" was obtained. The child received treatment with high doses of amphotericin B in conjunction with debridement and packing the lesions with calcium sulfate pellets. Recommended treatment for C. immitis infection of the bone would be debridement and packing with graft combined with systemic antifungal medical therapy.     

Fatal intracerebral gas gangrene in a 10-month-old child

Today, intracerebral infections by gas forming bacteria are very rare. They are mostly seen after penetrating injuries and more rarely after trivial trauma. Although prognosis of this kind of infection is severe, the general outcome of these patients after surgical and antibiotic treatment is good. We report a ten months old boy suffering a pecking injury just above the left ear with perforation of the temporal bone and dura. In between 48 hrs he developed a rapidly progressive gas gangrene encephalitis due to infection with C. perfringens and died despite of surgical and antibiotic treatment due to massive brain swelling and cardio-pulmonary failure.