Kaushani Chatterjee

Acute disseminated encephalomyelitis in a child with chikungunya virus infection

An 8-year-old boy was admitted to the Pediatric ward with high fever and severe arthritis of 4 days duration. Chikungunya virus serology was positive. As he became afebrile one week after admission, he developed acute onset right sided hemiparesis and suffered from one episode of generalized tonic clonic seizure. The next day he developed flaccid quadriplegia, loss of all sensory modalities below the C5 dermatome and urinary retention. After 4 weeks of shock stage, spasticity appeared in all 4 limbs. Magnetic resonance imaging (MRI) brain and spine showed extensive areas of demyelination-suggestive of acute disseminated encephalomyelitis (ADEM). He was treated with intravenous methyl prednisolone for 5 days, followed by oral prednisolone for 6 weeks. He was left with gross neurodeficits, including confinement to a wheel chair, persistent sensory loss and need for bladder catheterization.

Clitoral length and anogenital ratio in Indian newborn girls

ObjectivesTo generate normative data on clitoris length, anogenital distance and anogenital ratio in Indian newborns.DesignCross-sectional study.SettingNeonatal unit of a tertiary care teaching hospital in Kolkata.Participants378 female neonates, who were hemo-dynamically stable without critical illness or chromosomal anomaly, and without any vulval hematoma or genital abnormalities.InterventionsMeasurements were recorded using a digital vernier caliper between 24–72 hours. Infant was held in position by an assistant, while the investigator measured clitoral length by gently retracting the labia majora. Anogenital distance (centre of the anus to posterior convergence of the fourchette) and anogenital ratio (anogenital distance divided by the distance from centre of the anus to base of the clitoris) was also measured.Main outcome measuresGestational age- and birthweight-wise normative values of clitoral length, anogenital distance and anogenital ratios.ResultsMean clitoral length was 3.1 (1.54) mm for the whole cohort while anogenital distance and anogenital ratio were 10.2 (2.78) mm and 0.34 (0.07) mm, respectively. The gestation age-wise percentile charts of clitoral length, anogenital distance and anogenital ratio have been generated. There was no correlation between clitoral length and gestational age, body length, head circumference and birth weight. Correlations were also weak for anogenital distance.ConclusionsThe normative values generated can serve as reference standard in the assessment of clitoromegaly, ambiguous genitalia, virilizing effects and suspected in utero androgen exposure.

Flaccid quadriparesis due to severe myositis and Bell's palsy in pediatric dengue infection

A 10-year-old-boy was admitted with high grade continuous fever, rash, arthralgia and myalgia. From the 4 th day of fever, his myalgia increased in intensity and he developed flaccid quadriparesis on the 5 th day. Subsequently he was diagnosed to have dengue infection and myositis. He also developed right sided Bells palsy 4 days after he became afebrile. He was treated with intravenous methyl prednisolone for 3 days followed by oral prednisolone for 1 week with resultant dramatic resolution of myalgia and weakness. Physiotherapy was advised for Bells palsy. At follow up 2 months later, the child had regained grade 5/5 power in all four limbs, but the weakness of the facial muscles persisted.

Hansen’s chronic polyarthritis in a child

BackgroundMusculoskeletal manifestations of leprosy are often underdiagnosed and under-reported.Case characteristicsAn 11-year old girl with leprosy presented with deforming symmetric polyarthritis with raised inflammatory parameters and erosion on imaging.ObservationThe patient was diagnosed to have Hansen’s chronic polyarthritis and treatment started with non-steroidal anti-inflammatory drugs and methotrexate.MessageHansen’s chronic polyarthritis is a rare differential of juvenile chronic arthritis in children.