Özlem Bağ

Steroid-induced psychosis in a child: treatment with risperidone

Steroid-induced psychosis is one of the most serious adverse effects of steroid therapy but is a little-known complication in children. There is no clear mechanism model for steroid-induced behavioral disturbance, but it may be related with dose or level of free fraction of steroids. Our case is a 12-year-old boy diagnosed with steroid-induced psychosis and treated with risperidone, an atypical antipsychotic, due to distinct psychotic symptoms. Pediatricians should be aware of this rare complication when administering corticosteroids for various medical illnesses.

Alpha lipoic acid intoxication, treatment and outcome.

Alpha lipoic acid intoxication, treatment and outcome excluded an underlying intracranial abnormality. In the following few days he became conscious and his neurological fi ndings disappeared without further seizure recurrence and with normal electroencephalography. He was discharged on the fi fth day without sequelae. Evidence from literature shows that ALA is able to decrease oxidative stress caused by high levels of reactive oxygen and other free radicals. Furthermore, ALA has some activities that provide a cofactor for glucose metabolism in mitochondria. These effects are supposed to be benefi cial for cellular damage and hence its usage in diabetic patients, especially for whom neuropathy is common. 2 Half life of orally administered ALA is merely 30 min. 3 In animal studies, high levels of ALA were reported to cause apathy, hypokinesis, convulsions, and hepatotoxicity. Although there is no reported toxic dose in childhood, our patient likely ingested 226 mg/kg, which is above the LD50 for cats and dogs. 4 ALA has prooxidant effects at high doses, causing redox reactions with iron and affecting mitochondrial permeability. 2 Metabolic acidosis may thus be due to direct mitocondrial effect of ALA. We also speculate that high levels of ALA may attenuate energy utilization in brain and cause resistant convulsions. Our patient ’ s improvement may also be attributed to symptomatic management and the short elimination time of ALA. That ’ s why pediatricians and pediatric emergency medicine physicians should keep in mind ALA intoxication in children admitting with seizure, acidosis, and unconsciousness especially with a household treated for diabetic neuropathy.

Visceral Larva Migrans Presenting with Hypereosinophilia

Toxocariasis is an infection caused by the ingestion of larvae of the dog Toxocara canis or the cat Toxocara cati. A 2.5 year old boy was admitted to our clinics with fever, abdominal pain and loss of appetite. His medical history included geophagia (pica) and amebiasis infection. On admission, the physical examination revealed hepatomegaly and pallor. There was marked eosinophilia with leukocytosis, anemia, hypergammaglobulinemia and elevated serum Ig E titers. Toxocariasis was confirmed by anti-Toxocara IgG and Western blot. After 7 days of albendazole therapy, leukocytosis persisted and a second course of albendazole combined with prednisolone was administered. After 3 weeks, the eosinophil count had decreased and the patient showed resolution of hepatomegaly, but Toxocara serology remained elevated.

DRESS syndrome associated with type 2 diabetes in a child

Drug rash with eosinophilia and systemic symptoms (DRESS) syndrome is an uncommon, life-threatening drug reaction. The basic findings are skin rash, multiorgan involvement, and eosinophilia. Most of the aromatic anticonvulsants, such as phenytoin, phenobarbital and carbamazepine can induce DRESS. Herein we report a 14-year-old patient with DRESS syndrome related to carbamazepine use. The patient presented with signs of involvement of the skin, lungs, liver, and microscopic hematuria. Carbamazepine treatment was discontinued; antihistamines and steroids were started. Hyperglycemia, commencing on the first dose of the steroid given, persisted even after the discontinuation of steroids and improvement of other signs. There were no signs of pancreatitis or type 1 diabetes clinically in laboratory tests. Her blood glucose levels were regulated at first with insulin and later with metformin. Within 1 year of follow-up, still regulated with oral antidiabetics, she has been diagnosed with type 2 diabetes. Formerly, long-term sequelae related to “drug rash with eosinophilia and systemic symptoms syndrome” such as hepatic and renal failure, type 1 diabetes mellitus, Graves disease, autoimmune hemolytic anemia, and lupus have also been reported. However, up to date, no cases with type 2 diabetes have been reported as long-term sequelae. To our knowledge, this is the first case in the literature presenting with type 2 diabetes as long-term sequelae.

Factors Affecting Brucella spp. Blood Cultures Positivity in Children

Brucella infections have a wide spectrum of symptoms especially in children, making the diagnosis a complicated process. The gold standard for the final diagnosis for brucellosis is to identify the Brucella spp. isolated from blood or bone marrow cultures. The main purpose of this work was to evaluate the factors affecting the isolation of Brucella spp. from blood cultures. In our study, the ratio of fever, presence of hepatomegaly, and splenomegaly were found to be higher in the bacteremic group. In addition, C-reactive protein levels and liver function enzymes were found to be higher in the bacteremic group. In our opinion, while evaluating the febrile child with suspected Brucella infection, we highly recommend sampling blood cultures regardless of the history of previous antimicrobial therapy and duration of the symptoms.

Association of Celiac Disease With Idiopathic Pulmonary Hemosiderosis; Lane Hamilton Syndrome

Introduction: Idiopathic Pulmonary Hemosiderosis (IPH) is a rare cause of alveolar hemorrhage, which is seen primarily in childhood. Celiac disease is defined as a chronic, immune-mediated enteropathy of the small intestine, caused by exposure to dietary gluten in genetically pre-disposed individuals. Association of IPH and celiac disease is known as Lane Hamilton syndrome. There are limited number of case reports of this syndrome in literature. Case Presentation: Although there were no growth and developmental delay and gastrointestinal symptoms like chronic diarrhea, chronic constipation, vomiting, abdominal bloating and pain in the two patients with IPH, they were diagnosed with Lane Hamilton Syndrome. After initiation of gluten-free diet, their IPH symptoms disappeared and hemoglobin levels were observed to return to normal. Conclusions: Even if there were no gastrointestinal symptoms in a patient with IPH, celiac disease should be investigated. These patients may benefit from gluten free diet and IPH symptoms may disappear.

Infant colic or early symptom of autism spectrum disorder

Gastrointestinal (GI) disorders are common in autism spectrum disorder (ASD). Infant colic (IC), the functional GI disorder of infancy, has not been evaluated in this patient group. The aim of this study was therefore to determine the rate of IC in ASD and investigate a possible association between ASD and IC.

Trichobezoar in Vagina: Assessment for Child Sexual Abuse and Diagnostic Result of Forensic Science

Vaginal discharge and bleeding in children require a through and thoughtful evaluation to diagnose the underlying problem including infections, sexual abuse, and vaginal foreign bodies. We report a 6‐year‐old girl presenting with bloody vaginal discharge, carefully evaluated for sexual abuse, and finally diagnosed as a vaginal foreign body after vaginoscopy. A rolling hair ball was extracted from the vagina and was diagnosed as trichobezoar pathologically without any endo–ecto‐mesodermal residual tissue. The hair ball was genetically detected and diagnosed to belong herself by containing no foreign structure. Child sexual abuse was ruled out by forensic interview at CAC and report of forensic science that reported genetic structure belonging to the child. Medicolegal assessment helped in final diagnosis to exclude child sexual abuse.

Does mold sensitivity cause adenoid hypertrophy in children

Objective: Chronic adenoid infections, and allergic inflammation lead to development of adenoid hypertrophy. One of the major causes of allergic rhinitis due to allergic inflammation is indoor allergens, mainly house dust mites and molds. In this study, it was aimed to investigate the frequency of mold fungi sensitivity in the etiology of allergic rhinitis caused by adenoid hypertrophy in children. Methods: Among the patients who had been admitted to Pediatric Allergy Outpatient Clinic of Dr. Behçet uz Children Hospital, 34 cases with adenoidectomy were recruited. First, a questionarre including the risk factors and the symptoms were applied to the patients. Later, total eosinophil counts, serum total IgE and spesific IgE (m6) levels of the patients were examined and finally skin prick test was applied. Results: The age of the patients included in the study varied between five and nine years, seven (21%) of the patients were female and 27 (79%) of them were male. The the most frequent symptoms were nasal congestion (88%), snoring (82%), sweating (76%); the most frequently identified risk factors were enviromental smoke exposure (52%), use of air conditioning for warming (38%), and cold steam device (32%) respectively. Specific IgE (Alternaria) positivity was detected in 12% of the patients and mold sensitivity (Alternaria) in allergy skin test was detected in 18% of the patients. Conclusion: In children with adenoid hypertrophy,mold sensitivity should be investigated.

Higher-Than-Conventional Subcutaneous Regular Insulin Doses in Diabetic Ketoacidosis in Children and Adolescents

Objective: To evaluate the effect of initial insulin dosage on glycemic control in the first 48 hours of subcutaneous regular insulin therapy after resolution of diabetic ketoacidosis (DKA). Methods: Records of patients with DKA hospitalized in the past 3 years [n=76, median age=10.0 (6.0-12.0) years, Male/Female: 44/32] were reviewed. The patients were designated into two groups according to distribution of starting doses of subcutaneous insulin. Group 1 (n=28) received a median dose of 1.45 U/kg/day (1.41-1.5) and group 2 (n=48) a median dose of 0.96 U/kg/day (0.89-1). Clinical and laboratory data were analyzed. Results: Median, minimum, and maximum blood glucose levels of Group 1 in the first 48 hours of treatment were significantly lower than that of Group 2 [213 (171-242) vs. 255 (222-316), p=<0.001; 102 (85-151) vs. 129 (105-199), p=0.004; and 335 (290-365) vs. 375 (341-438), p=0.001, respectively]. The number of patients who experienced hypoglycemia (<70 mg/dL) were similar [Group 1, 5 (17.9%) vs. Group 2, 4 (8.3%), p=0.276] and none had severe hypoglycemia. In Group 1, the ratio of blood glucose levels within the target range (100-200 mg/dL) were higher (37.5% vs. 12.5%) and the number of results >200 mg/dL were lower (50% vs. 81.3%) compared to Group 2 (p=0.001 and p<0.001, respectively). Conclusion: After resolution of DKA, a higher initial dose of 1.4-1.5 U/kg/day regular insulin is associated with better glycemic control in children and adolescents without an increase in risk of hypoglycemia.