Devki Nandan

Complete right lung agenesis with dextrocardia: an unusual cause of respiratory distress.

Pulmonary agenesis, defined as complete absence of bronchus, parenchyma, and vessels is a very rare condition. Herein, we report a 4-month-old infant who presented with fever, cough, and respiratory distress and was misdiagnosed in a peripheral hospital as a case of pneumonia. The child was, later diagnosed as having right lung agenesis with dextrocardia.

Isolated tuberculous liver abscess in immunocompetent children – Report of two cases

Abstract Isolated tuberculous liver abscess (TLA) without active pulmonary or miliary tuberculosis, or other clinical evidence of tuberculosis, is distinctly rare and only few cases have been reported in the literature. We report two cases of isolated TLA in immunocompetent children, treated successfully by percutaneous aspiration followed by systemic antituberculous drugs.

Salmonella typhi presenting as acute glomerulonephritis in twin siblings

Summary Acute glomerulonephritis occurring during the course of enteric fever is a rare entity and only a few cases have been reported in the published literature. We describe two interesting cases of acute glomerulonephritis occurring in twin siblings.

Plasmodium vivax presenting as acute glomerulonephritis in a 3-year-old child

Although acute glomerulonephritis is a rare complication of Plasmodium falciparum malaria, it has not been reported in connection with Plasmodium vivax. We report a case of complicated P. vivax malaria presenting as acute glomerulonephritis. A three-year-old boy presented with high grade fever, a seven-day history of the progressive swelling of his body and a one-day history of vomiting. An examination revealed hypertension (>95th percentile), pallor and hepatosplenomegaly. Investigations showed a platelet count 80,000/mm3 with haematuria [20–30 red blood cells/high power field with more than 80% dysmorphic red blood cells]. A peripheral smear showed the presence of trophozoites of P. vivax. The patient was diagnosed as having P. vivax causing acute glomerulonephritis and was treated successfully with antimalarials and enalapril. With the changing epidemiological pattern of malaria, especially in endemic areas, unusual complications such as acute glomerulonephritis may sometimes present in cases of P. vivax malaria.

A Case of Empyema Thoracic due to Salmonella typhi in 18‑month‑old Child: An Unusual Cause

We herein report an 18-months-old child who presented with high-grade fever, cough, and breathlessness along with tachypnoea and diminished air entry on the left side of the chest, in which a diagnosis of left-sided pleural effusion was made. Salmonella typhi was isolated from the pleural tap culture. The patient had uneventful recovery with appropriate antibiotic therapy. Empyema thoracic as a complication is extremely rare in the absence of an underlying co-morbid illness, is even more uncommon in a child, and is even rarer to find with Salmonella typhi species. After reviewing the available literature we could find only five cases of empyema thoracic due to Salmonella typhi in children with the age range of 9–13 years. We are reporting this case as the youngest child reported with this complication.

Kimura’s disease presenting with inguinal lymphadenopathy in an 11-year old girl: A case report

Kimura’s disease (KD), mostly seen in young Asian boys, typically manifests with subcutaneous lesions and cervical lymphadenopathy. It has a good prognosis and has no risk of malignancy. Inguinal lymphadenopathy is rarely reported as a presenting feature of KD. Here we report such a case of KD in an 11-year old girl. The diagnosis of KD was confirmed in this case by characteristic histopathological findings of the excised lymph node.

Evaluation of the Protection Provided by Hepatitis B Vaccination in India

ObjectiveIn India, Hepatitis B vaccination is recommended at 6 wk except for hospital-deliveries. The authors examined protection afforded by the birth dose.MethodsA case-control study was done. HBsAg and HBcAb were tested in 2671 children, 1 to 5 y and HBsAb was evaluated in a subset of 1413 children. Vaccination history was recorded. Cases were HBsAg carriers. In another analysis, children who got infected (HBsAg and/or HBcAb positive) were considered as cases. Exposed were the unvaccinated. In another analysis, exposed were those vaccinated without the birth dose.ResultsThe odds ratio (OR) for HBsAg positivity with birth vaccination was 0.35 (95% CI 0.19–0.66); while with vaccination at 6 wk was 0.29 (95%CI 0.14–0.61), both compared to unvaccinated. Birth vaccination has no added protection when compared to the unvaccinated. Unvaccinated children in index study had HBsAg positivity of 4.38%. The number needed to treat (NNT) to prevent one case of HBsAg positivity was 32.6 (95% CI, 20.9 to 73.6). The odds of getting HBV infection was 0.42 (CI 0.25–0.68) with birth dose and 0.49 (CI 0.30–0.82) without the birth dose compared to the unvaccinated. Protective antibody (HBsAb) was present in about 70% of the vaccinated. In the unimmunised, in the first 2 y HBsAb protection was present in 40%. The odds ratio (OR) for HBsAb in the fully vaccinated between 4 and 5 y was 1.4 (95%CI 0.9–2.18) compared to the unvaccinated.ConclusionsThe present study lends support to the pragmatic approach of the Government to vaccinate babies born at home starting at 6 wk.

Chronic hypersensitivity pneumonia due to pigeon breeders’ disease

BackgroundPigeon breeders’ disease usually affects adults. Children are more likely to be affected when they share living space with a backyard poultry or pigeon breeding.Case characteristicsA 12-year-old girl with persistent cough for 3 years and dyspnea for 2 years.ObervationShe was dignosed to be having allergy to pigeon droppings, based on reports of lung biopsy and allergy testing.MessagePigeon breaders’ disease should be considered in a child who presents with features of chronic hypersensiticity pneumonitis.

Primitive neuroectodermal tumor presenting with superior vena cava syndrome

Peripheral primitive neuroectodermal tumor (PNET) of the chest wall is considered akin to Ewings sarcoma in terms of histology, immunohistology and cytogenetics. These tumors usually occur in children and young adults. These tumors usually present with cough, fever, chest pain and hemoptysis. Initial presentation as superior vena cava syndrome (SVCS) is rarely seen. Complete blockage of venous drainage in SVCS may lead to fatal outcome. These tumors are highly aggressive with a high incidence of local recurrence and distant metastases. Combination therapy comprising of chemotherapy, radiotherapy and surgery can be lifesaving in these patients. We present a case of primary mediastinal PNET in a 12-year-old girl. To the best of our knowledge, this is the first case of PNET presenting with SVCS in children.

X-linked hyper-igm syndrome with bronchiectasis

The X-linked hyper-immunoglobulin M syndrome (HIGM-1) is a rare genetic disorder characterized by elevated serum IgM levels and low to undetectable levels of serum IgG, IgA and IgE. These patients characteristically present with recurrent sinopulmonary infections and recurrent diarrhea. They also have high susceptibility for Pneumocystis jiroveci (PJ) pneumonia. Herein, we report a case of HGM-1 in a 5-year-old boy who presented with bronchiectasis and, possibly, PJ pneumonia. The diagnosis was established on the basis of clinical features, immune profile, whole blood flow cytometry and history of two male siblings death due to recurrent pneumonia and diarrhea.