Lumduan Wongsawasdi

Cytomegalovirus-associated manifestations involving the digestive tract in children with human immunodeficiency virus infection.

Objective To study the clinical manifestations of gastrointestinal cytomegalovirus disease in children with human immunodeficiency virus infection. Methods Review of clinical records of eight human immunodeficiency virus–infected children and histopathologically confirmed gastrointestinal cytomegalovirus disease from 1995 to 2001. Results Six of the eight children were younger than 1 year. The most common clinical presentations were fever and chronic diarrhea. Lower gastrointestinal hemorrhage and bowel perforation were noted in four and three patients, respectively. The colon was the most commonly affected site, followed by the small bowel and esophagus. The diagnosis was established by histopathology, obtained during endoscopy and surgery. Mucosal edema, erythema, and ulcer comprised the most common endoscopic findings. Two patients with fever, chronic diarrhea, and lower gastrointestinal bleeding developed remission after being treated with a 14-day course of ganciclovir. Conclusion Gastrointestinal cytomegalovirus disease can result in serious life-threatening complications, such as bowel perforation and massive gastrointestinal bleeding. Patients with chronic diarrhea and fever of unidentified cause might benefit from gastrointestinal endoscopy for early diagnosis and treatment. Although ganciclovir does not eradicate the infection and relapses are frequent, this treatment can prevent complications and reduce morbidity.

Hyaluronic acid : Additional biochemical marker in the diagnosis of biliary atresia

Background: The purpose of the present paper was to evaluate the value of biochemical markers, including conventional liver function tests, γ‐glutamyl transferase (GGT), and hyaluronic acid (HA), in the diagnosis of neonatal cholestasis.

Juvenile Polyp in Thai Children—Clinical and Colonoscopic Presentation

BackgroundThe aim of this prospective study was to describe the clinical characteristics of colorectal polyp in Thai children.MethodsFrom December 2002 to February 2005, children under 15 years of age presenting with rectal bleeding were prospectively enrolled. Demographic, clinical, and laboratory information was recorded. Location, number, characteristics, and histopathology of the polyps were noted.ResultsThere were 32 patients with a mean age of 6.5 years. The most common presenting symptom was hematochezia, followed by prolapsing rectal mass and diarrhea. In 20 patients there was a single polyp, 6 had 2–4 polyps, and 6 were diagnosed with polyposis coli. Most of the polyps were located exclusively at the rectum and sigmoid colon. In only 7 cases were the polyps proximal to the rectosigmoid region. This included 6 patients who had polyps beyond the splenic flexure. All were juvenile polyps without evidence of adenomatous changes. Compared to those with isolated polyps, the patients with polyposis coli had a statistically significant incidence of right-sided polyps (P <0.001) and a history of prolapse of the rectal mass (P = 0.006).ConclusionsBecause of the high prevalence of right-sided polyps and the concern about malignant transformation, colonoscopy should be considered as the initial evaluation in children with rectal bleeding.

Impact of gastrointestinal endoscopy on HIV‐infected children

Objective:  To evaluate the role of gastrointestinal (GI) endoscopy in human immunodeficiency virus (HIV)‐infected children with GI problems.

Acute respiratory distress syndrome following esophageal varice sclerotherapy

We report serious pleuropulmonary complications in a 6-year-old girl with an underlying extrahepatic biliary atresia who underwent esophageal varice sclerotherapy (EVS). The EVS was performed paravariceally with a 25-gauge disposable injection needle using polidocanol as a sclerosant. A total of 11 ml of the agent was injected in this session. The patient reported epigastric pain and developed a high fever with tachypnea at 11 and 17 h after the procedure, respectively. After 72 h following the EVS, she became dyspnic and required much more oxygen therapy. A follow-up chest X-ray revealed a moderate right pleural effusion and widening of the mediastinum. The arterial blood gas, obtained during FiO2 of 0.8, revealed PaO2 of 123 mmHg. Bilateral alveolar infiltration was noted in the follow-up chest X-rays. Acute respiratory distress syndrome (ARDS) was diagnosed. She was supportively treated with mechanical ventilator, broad-spectrum antibiotics, and right chest drainage. The patient was discharged home after a 3-week hospitalization with propranolol prophylaxis. A pathogenesis of ARDS following EVS was reviewed.

Case of eosinophilic granulomatous enterocolitis caused by Strongyloides stercoralis infection with marked hypoalbuminemia and ascites

We report a 10‐year‐old boy presenting with generalized pitting edema, ascites, abdominal pain, and chronic mucous diarrhea for 4 weeks. He had underlying diseases of hemoglobin E and juvenile rheumatoid arthritis and had been treated with immunosuppressive agents for a long period of time, including prednisolone and methotrexate. After extensive investigations, Strongyloides stercoralis infection, leading to protein‐losing enteropathy and eosinophilic granulomatous enterocolitis, was diagnosed. In the present report, we demonstrate early colonoscopic findings, revealing patchy erythema and small raised mucosal nodules with erosions at the cecum. Histopathological study showed open ulceration with cryptitis, intense infiltration of eosinophils and histiocytes with granuloma formation, in which Strongyloides stercoralis larvae were noted.