Ken-ichiro Kobayashi

Rare case of disseminated cysticercosis and taeniasis in a Japanese traveler after returning from India.

We report disseminated cysticercosis concurrent with taeniasis in a 31-year-old male Japanese, who had visited India three times and stayed for 1 month each time during the previous 1 year. The patient presented increasing numbers of subcutaneous nodules and expelled proglottids, although numerous cysts were also found in the brain in imaging findings, though no neurological symptoms were observed. Histopathological and serological findings strongly indicated cysticercosis. We found taeniid eggs in his stool by microscopic examination and revealed them as the Indian haplotype of Taenia solium by mitochondrial DNA analysis. We concluded that disseminated cysticercosis was caused by the secondary autoinfection with eggs released from the tapeworm carrier himself. After confirming the absence of adult worms in the intestine by copro-polymerase chain reaction, the patient was successfully treated with albendazole at a dose of 15 mg/kg/day for 28 days. Subcutaneous and intracranial lesions had completely disappeared by the end of the treatment period.

Cerebral hemorrhage associated with vitamin K deficiency in congenital tuberculosis treated with isoniazid and rifampin.

We report a male infant with congenital tuberculosis who developed cerebral hemorrhage associated with vitamin K deficiency during treatment with isoniazid and rifampin. Despite an absence of risk factors for vitamin K deficiency, the severe hemorrhagic disorder occurred at 4 months of age. We speculate that vitamin K deficiency in the present case may have resulted from a synergic effect of antituberculosis agents and immaturity of vitamin K metabolism and/or its absorption.

Clinical spectrum in hospitalized children with echovirus type 13 infection.

Abstract Background :u2002The aim of this study was to investigate the clinical spectrum of echovirus type 13 (E13) infection in hospitalized children.

Reversible Vascular Changes in Children With Cerebral Infarction

A case of cerebral infarction in a 4-year-old male is described. The child presented with an acute onset of right hemiplegia, central facial palsy, and dysarthria. He had no predisposing factors for cerebral infarction. A computed tomography scan showed a diffuse low-density area in the territory of the left middle cerebral artery. Magnetic resonance angiography disclosed multiple irregular narrowings in the left anterior and middle cerebral arteries. He recovered spontaneously from the stroke with minimal long-term complications, and repeated angiography disclosed a complete regression of the vascular changes 2 months after the stroke. There was no recurrence of stroke after 2-year follow-up. This case demonstrates the importance of longitudinal angiographic follow-up in childhood cerebral infarction of idiopathic origin. (J Child Neurol 2002;17:61-63).

Acute Vulvar Ulceration as the Main Presenting Manifestation of Hemophagocytic Syndrome

A 14-year-old female exhibited an acute vulvar ulcer during the course of hemophagocytic syndrome (HPS). The patient presented persistent high fever and a deep painful vulvar ulcer lasting for more than 2 weeks. Neither infection with sexually transmitted agents nor autoimmune disorder were found to be positive. The presence of hemophagocytosis in the bone marrow and elevation of urinary g -2-microglobulin ( g -2M) prompted the diagnosis of HPS. Acute vulvar ulcer is rare, but it should be recognized as a mucous manifestation of HPS. During the clinical course, urinary g -2M was the most sensitive marker for the evaluation of the disease activity of HPS.

Serum Immunoglobulin Levels at Onset: Association with the Prognosis of Childhood Idiopathic Thrombocytopenic Purpura

Between 1981 and 2000, 87 patients with new diagnoses of idiopathic thrombocytopenic purpura (ITP) were admitted to the pediatric department of Kobe City General Hospital or Nishi-Kobe Medical Center. The patients’ clinical records were analyzed for the relationships of disease outcome to serum immunoglobulin levels and other factors, including sex, onset age, and initial platelet counts.The disease of 22 patients became chronic, and of the 65 patients with an acute form of the disease, 27 exhibited levels of immunoglobulin G (IgG), IgA, or IgM above the 97.5% confidence limits of the age-matched control subjects. However, only 2 patients with the chronic form of the disease showed elevated serum immunoglobulin levels. The presence of antecedent specific viral infections was also associated with the acute disease form. In predicting the prognosis of childhood ITP, high serum immunoglobulin levels at initial presentation can be considered a good prognostic marker for the acute form of the disease.

Mycotic Aneurysm of a Persistent Sciatic Artery

An 83-year-old febrile woman presented with leg pain. Her lateral right thigh was swollen, but no neurological or ischemic findings were noted. A computed tomography scan showed an abnormal right internal iliac artery leading directly into the posterior aspect of the thigh, which was determined to be a persistent sciatic artery (PSA) (Picture). The PSA was thrombosed, dilated, and surrounded by enlarged multiple nodular aneurysms, with irregular wall thickening and perivascular edema indicative of infection. Methicillin-resistant Staphylococcus aureus (MRSA) was detected from blood cultures, and an MRSA mycotic aneurysm of a PSA was diagnosed. Her symptoms resolved gradually with intravenous vancomycin. Oral antibiotics were unavailable, so she remains under close observation after 12 weeks of treatment. Aneurysmal enlargement and thromboembolism of a PSA may bring about complications such as limb ischemia and neuralgia (1). The development of a mycotic aneurysm of the type we encountered is notably rare (2).