Acute hemiparesis revealing a neuroborreliosis in a child]

We report on a 11-year-old boy who had 2 acute hemiparesis episodes over a period of 1 month. He suffered from headache and fatigue since 1 year. He could not remember neither a tick bite nor a local erythematous skin lesion. The diagnosis of neuroborreliosis was based on intrathecal production of specifics antibodies. Furthermore, the CSF/blood glucose ratio was decreased (0.14), which was rarely described. Cranial MRI showed left capsulothalamic inflammation and a vasculitis. The patient was successfully treated by ceftriaxone. Neuroborreliosis should be considered in all children with stroke-like episode, even in the absence of a history of a tick bite.     

Laryngitis revealing bacterial tracheitis in a five-year-old child]

CASE REPORT: We report the case of a five-year-old boy with clinical features of croup and left lower lobe pneumonia. Response to inhaled adrenaline and dexamethasone was incomplete and he developed respiratory distress. Direct laryngoscopy performed in the operating room showed mild glottic and subglottic inflammation. On bronchoscopy, there was thick pus coming from the left lower lobe. He was intubated for three days and regular toilet brought back thick pus. Tracheal fluid culture grew Haemophilius influenzae. COMMENTS: We suggest that he had bacterial tracheitis but that the tracheal involvement was not prominent at the time of diagnosis. CONCLUSION: Laryngoscopy and bronchoscopy in specialized surroundings should be considered for each child with croup unresponsive to conventional treatment, especially in case of lower respiratory tract involvement.     

Ovarian torsion revealing an ovarian cavernous hemangioma in a child]

The authors report one case of cavernous hemangioma of the left ovary, which was revealed by ovarian torsion. Such benign tumors of the blood vessels are rare in ovaries during childhood. This hemangioma was observed in a 13-year-old patient, who presented with abdominal and pelvic pain and vomiting. The pelvic mass was noted and sonography revealed a cystic tumor. An annexectomia was realized. Histology showed narcotized ovary cells, with an increased number of vascular channels composed of thin walled vessels, whose wall consisted of an endothelium. This aspect evoked a cavernous hemangioma of the ovary.     

Chronic otitis and hearing loss revealing a disseminated tuberculosis in a child]

Ear localization is sometimes the first symptom of tuberculosis. CASE REPORT: We report a case of a teen with a chronic otitis revealing a disseminated tuberculosis. The investigations showed ear, bones and pulmonary localisations. The outcome with treatment showed a persistent hearing loss. CONCLUSION: Middle ear tuberculosis should be suspected in patients with chronic otitis and risk factors of tuberculosis. A disseminated tuberculosis should be investigated and an early treatment is necessary to prevent hearing loss.     

Hypercalcemia revealing iatrogenic hypervitaminosis A in a child with autistic troubles]

Hypervitaminosis A is an unusual cause of infant hypercalcemia. The way it occurs can be very surprising, as one can notice from the following case report. CASE REPORTS: A three-year-old boy, presenting important behavioral disorders, was hospitalized because of a deterioration of his general state of health associated with vomiting, cephalgias, fever and cutaneous abnormalities. A 168 mg/L hypercalcemia was found. The only etiology is a deviant consumption of vitamin A within the framework of an "autistic diet": 100000 UI/d during three months, and then 150000 UI/d the three following months. Intoxication was confirmed by the increased vitamin A plasmatic level, and vitamin A/RBP molar ratio and by the presence of plasmatic retinyl palmitate. An emergency treatment by rehydration, biphosphonates and furosemide led to effective calcemia normalization. CONCLUSION: In the case of nonobvious causes of hypercalcemia, a thorough cross-examination must look for vitamin A intoxication. Our observation illustrates the danger of certain diets suggested for autistic children.     

Metrorrhagia and precocious puberty revealing primary hypothyroidism in a child with Down's syndrome

We report a child with Down's syndrome in whom metrorrhagia and precocious puberty revealed primary autoimmune hypothyroidism. The patient had a decreased growth velocity, exaggerated weight gain, bone age delay, and bilaterally enlarged multicystic ovaries. Delays in the diagnosis and treatment of hypothyroidism can lead to this peculiar presentation.     

Metrorrhagia and precocious puberty revealing primary hypothyroidism in a child with Down's syndrome.

We report a child with Down's syndrome in whom metrorrhagia and precocious puberty revealed primary autoimmune hypothyroidism. The patient had a decreased growth velocity, exaggerated weight gain, bone age delay, and bilaterally enlarged multicystic ovaries. Delays in the diagnosis and treatment of hypothyroidism can lead to this peculiar presentation.     

Pneumothorax revealing cystic adenomatoid malformation of the lung in a 13 year old child]

CASE REPORT: A 13 year old boy had a seven day history of chest pain and dyspnea. His right hemithorax was immobile with abolished breathing sounds. Initial chest X-ray revealed a right tension pneumothorax. A chest tube was inserted and the right lung re-expanded. However, despite two intrapleural injections of tetracyclin, the pneumothorax reappeared. Lung CT scan showed an intraparechymal cyst in the posterior part of the right upper lobe. Lobectomy was performed and histological study confirmed the diagnosis of type I cystic adenomatoid malformation of the lung. Two months after surgery, clinical and radiological examinations were normal. CONCLUSION: Spontaneous pneumothorax, as the initial manifestation of cystic adenomatoid malformation of the lung, is rare (three cases reported in children beyond the neonatal period, and two in adults). CT scan features correlate well with the pathologic features. Because of the risk of recurrent pulmonary infections and malignancy change, removal of the cystic lesions is advisable.     

Splenic infarction in a child revealing chronic myeloid leukemia

A 7-year-old girl was admitted with a severe abdominal pain. Abdominal ultrasound and CT revealed a large splenic infarction, leading to the diagnosis of chronic myeloid leukemia.     

百白破混合制剂致血尿一例

患儿女 ,6个月。于 3个月龄时注射百白破混合制剂 0 .5ml。次日发现肉眼血尿 ,体温正常。否认近期有其他药物应用史。体检无异常发现和其他部位出血 ,纯母乳喂养。化验尿常规示红细胞 ( + + + + )。血常规 ,血小板计数 ,出、凝血时间和肾功能检查均正常。排尿数次后血尿消失。 4个月时再次注射百白破混合制剂 0 .5ml ,次日再次出现血尿。化验尿常规示红细胞 ( + + + + )。排尿数次后渐变淡后消失。 5个月龄时第 3次注射百白破 0 .5ml,约在注射后 10小时后第 3次出现血尿 ,排尿 4次后消失。讨论 :本例在 3次注射百白破疫苗后均出现血尿。并排…     

Hematuria in pediatric clinical practice]

Haematuria, which was known at the time of Hippocrates, is defined as the presence of an anomalous number of red globules in the urine. It may present itself in a macroscopic or microscopic form. The latter is frequently found and is present in 1-2% of children. The pathogenesis of haematuria has been the object of recent acquisitions. The diagnosis is based in the first instance on the association of a positive urinary stick and confirmation of the presence of red globules in an assay of the sediment. The study of erythrocytic morphology is still the most useful test to identify the site of bleeding, even if more recently other markers, such as an excessive presence of acanthocytes or reduced mean corpuscle volume, together with the traditional study of cylindruria may represent elements to differentiate between glomerular and non-glomerular haematuria. Both family and personal medical history as well as objective examination play an important role in the definition of haematuria. Abdominal ultrasonography and biohumoral tests may, in association with the earlier data, allow a rapid and correct diagnosis of children with haematuria. A more detailed diagnosis using biopsy should be taken into consideration in selected cases, for example in familial forms that are not clearly defined and forms associated with altered renal function tests, as well as in persistent microhaematuria lasting for more than one year.     

Hematemesis in an 11-month-old child: an unusual symptom revealing a foreign body in the stomach]

Ingestion of foreign body has often no consequence. We report on a case in an 11-month-old girl who was referred for mild hematemesis and anorexia. Upper digestive tract endoscopy found a small metallic foreign body in the gastric antrum. After its removal, all symptoms disappeared. It is usually recommended to remove foreign bodies by endoscopy when they are in esophageal position, or are more than 3 to 5 cm long, or have a shape that may hurt the gut mucosa. Although rare, a gastric foreign body should be searched for in face of an upper gastrointestinal bleeding in an infant.     

Hematuria due to urolithiasis in a child with chronic immune thrombocytopenic purpura

Hematuria is an uncommon manifestation of chronic immune thrombocytopenic purpura. The occurrence of urolithiasis in children with chronic immune thrombocytopenic purpura has not been described. We report a case of hematuria due to urolithiasis in an 8-year-old boy with chronic immune thrombocytopenic purpura. This child, who had a history of immune thrombocytopenic purpura of 1 year's duration, presented to the emergency department with gross hematuria. The cause of hematuria was initially attributed to his primary disease process. A careful history, examination, and pertinent investigations revealed that the hematuria was secondary to urolithiasis. This report highlights the need to keep an open mind and to search for specific causes of bleeding, even in children with known bleeding disorders.     

Cutaneous symptoms revealing a monoblastic leukemia]

Leukemia cutis (LC) are not rare in acute myeloid leukaemia (AML) in children but exceptionally reveal it. Most authors think that they have poor prognosis. CASE REPORT: We report the case of an infant with isolated cutaneous involvement at the time of diagnosis of leukaemia. Bone marrow aspiration showed AML M5. The child was treated by LAME 91 protocol, arm "infant under one year of age". Complete remission, both in bone marrow and skin, was obtained after induction course. Then the patient received consolidation course and megatherapy followed by autologous bone marrow transplantation. Skin relapse occurred early. The complete remission no. 2 was not obtained by second line treatment: new LC appeared when PMN count increased more than 10(9)/l. Then, the child was treated with oral VP16 but disease progressed with more and more LC, followed by bone marrow relapse. Child's death occurred about one year after diagnosis.