Harvey J. Hamrick

Bacteremia in 28 Ambulatory Children Relationship to Pneumonitis and Meningitis

Bacteremia with known pathogens was documented in 28 acutely ill, febrile outpatients during a 29-month period. All of the children were previously healthy and were initially managed as outpatients. Eight patients presented with no identifiable focus of infection. Twenty patients had either otitis media or pneumonitis. An association between otitis media and bacteremia with H. influenzae type b was noted in 5 patients. Bacterial meningitis occurred subsequently in 7 patients (25 per cent); 1 death occurred in this group. The blood culture, as an outpatient procedure, was helpful in establishing a bacterial etiology in selected chidren with either high fever (with or without otitis media), febrile seizures, or pneumonia. In addition, the positive blood culture was a vital aid in identifying the young child at risk for meningitis.

Kimura's disease: Report of a pediatric case in the United States

A 14-year-old male adolescent is described with a 6-year history of active lymphadenopathy, skin rash, peripheral blood eosinophilia, and markedly elevated serum-IgE level. Complete histopathologic and immunologic evaluations established the diagnosis of Kimuras disease as first described in Japan. Because of its relative infrequency and varied features, this disorder can be difficult to diagnose when it is encountered in the United States.

CHILDHOOD NON-HODGKIN LYMPHOMA PRESENTING AS HEMOPHAGOCYTIC SYNDROME

An 8-year-old girl with a progressive systemic hemophagocytic syndrome was found to have non-Hodgkin lymphoma (NHL) after multiple nondiagnostic biopsies. Routine histochemistry and flow cytometry demonstrated this to be a peripheral T-cell process and cytogenetics identified a t(2;5)(p23;q35). An extensive evaluation for an infectious agent failed to identify a pathogen. Treatment according to a standard lymphoma protocol produced a rapid response and the girl remains in remission without evidence of hemophagocytic syndrome 18 months from diagnosis. In children with systemic hemophagocytosis, a diagnosis of NHL should be aggressively pursued.

Cryoglobulinemia and Glomerular Rhomboid Inclusions in a Child With Acute Kidney Injury

Cryoglobulinemia is rarely reported in children, and kidney failure secondary to cryoglobulinemia is even more uncommon. We report the case of a 7-year-old boy with cryoglobulins and a systemic illness, including persistent fever, arthralgias, rash, hypocomplementemia, and acute kidney injury associated with nephritic urine sediment. An extensive workup showed no infectious, neoplastic, or rheumatological cause of his kidney injury. The kidney biopsy specimen showed membranoproliferative glomerulonephritis type 1 with electron microscopic evidence of rhomboid crystalloid inclusions. These inclusions have rarely been reported in adult patients with cryoglobulinemia. The patient underwent spontaneous remission, including full recovery of kidney function, and required no immune suppression. The patients course is consistent with cryoglobulinemia-associated kidney injury, which supports the inclusion of essential cryoglobulinemia in the differential diagnosis of pediatric patients with hypocomplementemic glomerulonephritis.

Systemic Loxoscelism in a Nonendemic Area: A Diagnostic Challenge for the Unsuspecting Physician

Except for the far western tip, North Carolina is not considered within the ecological range of brown and other recluse spiders (Loxosceles sp.). All published reports of systemic loxoscelism are from the states of Kansas, Missouri, Oklahoma, Arkansas, Texas, Indiana, and Tennessee, which are within the defined range. The occurrence of 2 cases in central North Carolina during a 4-month period (March to June 2013) emphasizes the need to alert physicians practicing in nonendemic areas to the clinical features and the risk of potentially serious complications in children.