Decreased hepatic uptake of gallium-67 citrate in haemophagocytic syndrome occurring concomitantly with capillary leak syndrome

We describe a 4-year-old girl with haemophagocytic syndrome (HPS) in whom hepatic gallium-67 citrate (Ga-67) uptake was suppressed when the disease was in its acute phase and returned to normal when the disease was in remission. The prominent clinical feature of this case was the occurrence of systemic capillary leak syndrome (CLS). Because extravasation of plasma proteins may be the result of vascular endothelial injury in CLS, loss of hepatic Ga-67 uptake may reflect insult to the hepatic sinusoidal endothelium. This case suggests a possible role of sinusoidal endothelial cells in the mechanism of hepatic Ga-67 uptake and indicates the need for further study of Ga-67 uptake in patients with HPS.     

Coxsackie virus B 4 encephalitis in a 7 year old boy

BACKGROUND: Enteroviruse belongs to the family of picornaviruses. They can be devided in 4 groups: polioviruses (Typ 1-3) enteric cythopathogenic human orphan (ECHO)- viruses, unclassified enteroviruses 68-71 and coxsackie viruses. Coxsackie virus type B can cause pharyngitis, myalgia, myocarditis and meningitis as well as severe neonatal infections. CASE REPORT: We report a patient with coxsackie type B 4 encephalitis. A 7 year old boy had 2 episodes of mental dizziness and consciousness disturbance. Because of he presented a visus of 70 %, headaches and vomiting he was admitted to our hospital. In the cerebrospinal fluid a coxsackie virus type B 4 could be identified. With nonspecific therapy the boy recovered. CONCLUSION: We concluded that coxsackie virus B 4 caused acute encephalitis with ophthalmological and mental symptoms and good prognosis. Coxsackie virus B 4 should be considered in patients with encephalitis.     

Pulmonary gallium-67 uptake in diffuse pulmonary calcinosis

Diffuse pulmonary uptake of both technetium-99m-labeled methylene diphosphonate (99^mTc-MDP) and gallium (⁶⁷Ga) citrate was noted in a patient with chronic renal failure and indicated the presence of pulmonary calcinosis. The uptake of⁶⁷Ga could be misinterpreted to represent abnormal uptake due to an opportunistic infection.     

Prolactin-producing pituitary adenoma in a 9 year old boy

A boy aged 9 years and 8 months was evaluated for headache and an enlarged sella. His neurological status and visual fields were normal. After injection of radiographic contrast agent, computerized axial tomography showed evidence of an intrasellar tumor. The most striking endocrine abnormalities were growth hormone insufficiency after arginine infusion and after insulin-induced hypoglycemia, and excessively elevated prolactin levels ranging between 1220 ng/ml and 1560 ng/ml. A slightly granulated, acidophilic pituitary adenoma was selectively removed by the trans-sphenoidal approach. The function of the anterior pituitary improved post-operatively. Growth hormone secretion after insulin-induced hypoglycemia returned to normal, and the basal serum prolactin levels decreased, but are still three times higher than normal.     

Thymic rebound following successful chemotherapy of B-lymphoma in an adolescent boy

Four months after termination of successful chemotherapy for epipharyngeal B-non-Hodgkin lymphoma, an enlarging anterior mediastinal mass was discovered in a 15-year-old boy. There was no other suspicion of tumour recurrence. A simple thymic rebound was likely and a conservative management was chosen. Follow up for more than 12 months was uneventful. The frequency of thymic hyperplasia after termination of chemotherapy is discussed. It is a benign immunological rebound phenomenon and does not require operative intervention.     

Mycoplasma pneumoniae associated organising pneumonia in a 10 year old boy

We describe a 10 year old boy with organising pneumonia associated with acute Mycoplasma pneumoniae infection. The diagnosis of organising pneumonia was made by open lung biopsy and the M pneumoniae infection was proven serologically. Antibiotic and long term corticosteroid treatment resulted in steadily improving pulmonary function monitored by spirometry. The introduction of anti-inflammatory treatment with NSAIDs/immunosuppressive agents in order to spare steroids was well tolerated and resulted in further improvement of the pulmonary function. To our knowledge this is the first documented case of Mycoplasma pneumoniae associated organising pneumonia to be reported in a child.     

Pseudo-Acanthosis nigricans in a 12 year old boy after kidney transplantation

Cutaneous lesions under immunosuppressive therapy require a specific diagnostic approach. We present the case of a 12 year old boy who developed pseudo-acanthosis nigricans 3 months after renal transplantation.     

Juvenile type of chronic myeloid leukaemia in a four year old boy

Chronic myeloid leukaemia (CML) is a rare disease in children. Three varieties of CML occur in childhood. Juvenile (Infantile), adult and familial types, each with distinct clinical and laboratory findings. Prognosis of all these types of CML in childhood is uniformly bad. The mean survival of a juvenile CML is 9 months and that of adult variety is 2.5 years. The adult form of childhood CML responds to therapy, but the patient succumbs to the disease during the blast crisis. Various modalities of treatments are being tried in the juvenile CML without any beneficial effect. We report a case of juvenile CML with characteristic findings in a four year old boy.