Shilpi Agarwal

Hemophagocytic syndrome associated with visceral leishmaniasis.

The present paper reports a case of 6-year-old male child, suffering from pallor, fever and hepatosplenomegaly. A clinical diagnosis of enteric fever with a second possibility of malaria was considered. Laboratory findings included bicytopenia, hyperbilirubinemia and raised liver enzymes. Bone marrow examination revealed active hemophagocytosis. On extensive search few amastigote forms ofLeishmania donovani were seen. Patient was negative for other viral, bacterial and malaria infections. The final diagnosis of hemophagocytic syndrome associated with visceral leishmaniasis was made. There was response of anti-Leishmanial treatment with improvement in clinical condition.

Maternal serum interleukin-6 and its association with clinicopathological infectious morbidity in preterm premature rupture of membranes: a prospective cohort study

Objective: To analyze the association of maternal serum interleukin-6 (IL-6) with fetomaternal outcome in preterm premature rupture of membranes (PPROM). Methods: Serial serum IL-6 levels were measured in 45 women with PPROM at gestation 24–34 weeks. The women were followed till pueperium and fetomaternal outcome as well as the histopathology of the placenta and the umblical cord was studied. The data were analyzed using t test and χ2 test. Results: IL-6 levels ≥ 8 pg/ml were significantly associated with puerperal sepsis and neonatal sepsis. Histological chorioamnionitis and funisitis were demonstrated in 48.8% and 13.3% women respectively and significantly correlated with elevated serum IL-6 levels and fetomaternal infection. A cut-off value of IL-6 of 8 pg/ml was found to correctly diagnose 19 out of 23 patients with infectious morbidity and showed the best sensitivity (82.6%) and specificity (86.3%) as compared to the total leucocycte count (TLC) and C-reactive protein (CRP) in diagnosing infection in PPROM. Conclusion: Maternal serum IL-6 can be used as a biomarker to predict preclinical asymptomatic infection in PPROM with good sensitivity and specificity.

Pigmented basal cell carcinoma: Cytological diagnosis and differential diagnoses

Pigmented basal cell carcinoma is a rare cutaneous neoplasm with only a few cases reported so far. Review of the literature yielded only an occasional fine-needle aspiration report of the cytologic features of the tumor.We report a rare case of pigmented basal cell carcinoma occurring on the thigh of a 55-year-old woman. The cytological features are described with discussion over the possible differential diagnoses.

Primary Burkitt lymphoma of kidney: A rare presentation in a child

Primary renal Burkitt lymphoma (BL) is an unusual occurrence in children. Although the prognosis of this tumor is poor, early diagnosis on biopsy confirmed by immunohistochemistry (IHC) and followed by chemotherapy improves survival of such patients. We present a case of 4-year-old male child with bilateral renal lump suggestive of lymphoma on computerized tomography. Renal biopsy and subsequent IHC was suggestive of bilateral BL in the kidney; following which the child was started on FAB LMB 96 based treatment protocol.

Pilomatricoma coexistent with epidermal cyst.

complicating squamous cell carcinoma. Three cases of opportunistic infestation of an ulcerative, neglected SCC with Diptera larvae, and another case following radiotherapy for SCC of the temple have been reported. The treatment of myiasis consists of mechanical or surgical removal of the larvae with hemostatic or ordinary clinical pincers, or techniques involve blocking the spiracles of the larva and stimulating premature extrusion. Surgical management is most frequently recommended. Preventive measures, including basic health care, hygiene, and access to primary health services, are fundamental to prevent cases such as this one.

Importance of cutaneous findings in childhood scleromyositis in Indian scenario

Sir, Scleromyositis is a syndrome combining clinical features of both dermatomyositis and systemic sclerosis (SSc), but differing from both by a chronic and a relatively benign clinical course and association with highly characteristic PM-Scl antibody.[1] There are very few case reports of childhood scleromyositis (CSM) in English literature with only occasional case reports from India. PM-Scl antibody testing is routinely done in all suspected cases of CSM in developed countries, whereas in Indian scenario, PM-Scl antibody testing is costly and not routinely available. Hence, diligent clinical and histopathological examination is cheaper and reliable for the diagnosis of scleromyositis.

Henoch–Schönlein purpura with uveitis: an unusual case and review of literature

Henoch–Schönlein purpura (HSP) is a small vessel vasculitis with IgA dominant immune complex deposition. It is characterized by a triad of palpable purpura (without thrombocytopenia), abdominal pain and arthritis. Uveitis is rarely associated with HSP with only 3 cases reported in literature. All these cases were in adult population and were associated with nephritis. However, this association is not reported in paediatric age group. We are reporting a case of an 11-year-old child of recurrent HSP with uveitis.

Chronic idiopathic myelofibrosis with myeloid metaplasia presenting as refractory ascites.

Chronic idiopathic myelofibrosis (CIM) with myeloid metaplasia is a myeloproliferative disorder characterized by leukoerythroblastosis, tear drop erythrocytes, extra‐medullary hematopoesis (EMH), and varying degree of myelofibrosis. CIM, presenting as refractory ascites secondary to peritoneal hematopoesis, is extremely rare with only six adult cases reported in literature. This is a report of a child with CIM presenting as refractory ascites as a consequence of EMH in the peritoneum. The patient was treated with intermittent hydroxyurea with favorable response over 3 weeks. The patient was thereafter lost to follow up. Pediatr Blood Cancer 2010; 54:151–153.

Metastatic tubercular gummas and splenic tuberculoma secondary to tubercular lymphadenitis in an immunocompetent female

Tubercular gummas and splenic tuberculomas are rare forms of extrapulmonary tuberculosis, usually occurring in immunocompromised individuals. We hereby report a rare combination of multiple tubercular gummas and splenic tuberculoma secondary to TB lymphadenitis in an immunocompetent individual. The patient responded to antitubercular therapy. Thus, in a developing country like ours, tuberculosis can present in a wide clinical spectrum even in an immunocompetent individual.

Childhood lichen planus: A series of 42 Indian patients

Background: Lichen planus (LP) is a papulosquamous disease of unknown etiology that is relatively uncommon in children. There is a paucity of data on the clinical profile of LP in children. Available case series are few and majority being retrospective. A cross-sectional observational study to evaluate the clinical profile of childhood LP was performed. Materials and Methods: All childhood cases (<18 years) with histopathologically confirmed diagnosis of LP were evaluated. Detailed clinical history, examination, and investigations were performed according to a proforma. Observation and Results: There were 42 children and childhood LP constituted 1.4% of the pediatric dermatoses. There were 26 females (61.9%) and 16 (38.1%) males with male to female ratio of 1:1.6. The age ranged from 2 to 18 years with a mean age of 11.6 ± 5.1 years. The duration of the disease ranged from 15 days to 5 years with a mean of 8.6 ± 9.4 months. History of recent hepatitis B vaccination was found in 6 (14.3%) patients, and exposure to X-ray radiation was seen in 3 (7.1%). The most common morphological presentation of LP was papules and plaques observed in 34 (81%) patients. Classical LP was the most common variant, found in 29 (69%) patients, followed by hypertrophic variant in 7 (16.7%) patients. Koebnerization was found in 31 (73.8%) patients. Oral mucosa involvement was seen in 28.6% of patients, nail in 42.85%, and scalp in 7.1% of patients. Conclusion: Childhood LP resembles adult LP in most of the aspects. However, etiological factors in childhood LP may be different. It is an under-reported disease. Large multi-centric prospective studies should be undertaken to acquire a better understanding of the clinical profile of childhood LP.