Vivek Dewan

Complete right lung agenesis with dextrocardia: an unusual cause of respiratory distress.

Pulmonary agenesis, defined as complete absence of bronchus, parenchyma, and vessels is a very rare condition. Herein, we report a 4-month-old infant who presented with fever, cough, and respiratory distress and was misdiagnosed in a peripheral hospital as a case of pneumonia. The child was, later diagnosed as having right lung agenesis with dextrocardia.

Plasmodium vivax presenting as acute glomerulonephritis in a 3-year-old child

Although acute glomerulonephritis is a rare complication of Plasmodium falciparum malaria, it has not been reported in connection with Plasmodium vivax. We report a case of complicated P. vivax malaria presenting as acute glomerulonephritis. A three-year-old boy presented with high grade fever, a seven-day history of the progressive swelling of his body and a one-day history of vomiting. An examination revealed hypertension (>95th percentile), pallor and hepatosplenomegaly. Investigations showed a platelet count 80,000/mm3 with haematuria [20–30 red blood cells/high power field with more than 80% dysmorphic red blood cells]. A peripheral smear showed the presence of trophozoites of P. vivax. The patient was diagnosed as having P. vivax causing acute glomerulonephritis and was treated successfully with antimalarials and enalapril. With the changing epidemiological pattern of malaria, especially in endemic areas, unusual complications such as acute glomerulonephritis may sometimes present in cases of P. vivax malaria.

A Case of Empyema Thoracic due to Salmonella typhi in 18‑month‑old Child: An Unusual Cause

We herein report an 18-months-old child who presented with high-grade fever, cough, and breathlessness along with tachypnoea and diminished air entry on the left side of the chest, in which a diagnosis of left-sided pleural effusion was made. Salmonella typhi was isolated from the pleural tap culture. The patient had uneventful recovery with appropriate antibiotic therapy. Empyema thoracic as a complication is extremely rare in the absence of an underlying co-morbid illness, is even more uncommon in a child, and is even rarer to find with Salmonella typhi species. After reviewing the available literature we could find only five cases of empyema thoracic due to Salmonella typhi in children with the age range of 9–13 years. We are reporting this case as the youngest child reported with this complication.

An Unusual Presentation of Addison’s Disease—A Case Report

Addison’s disease is most commonly due to autoimmune adrenalitis and tuberculosis and refers to primary hypoadrenalism caused by a total or near total destruction or dysfunction of both adrenal cortices. Usual manifestations involve chronic fatigue, muscle weakness, loss of appetite, nausea, vomiting, diarrhea, hypotension and hyperpigmentation of skin. We herein report a case of primary adrenal insufficiency presenting with fever and seizures in an 11-yr-old boy. His symptoms resolved after starting specific therapy. This kind of presentation of Addison’s disease is rather unusual.

Power Color Doppler and Spectral Doppler Ultrasonography to Evaluate Response to Intra-articular Steroid Injection in Knee Joints in Juvenile Idiopathic Arthritis.

ObjectiveTo evaluate the role of ultrasonographic indices (Color Fraction and Resistive Index) in assessing the effect of intra-articular steroid (IAS) injection on synovial inflammation in knee joints of Juvenile Idiopathic Arthritis (JIA) patients and to determine the correlation between these ultrasonographic indices and clinical and laboratory parameters in JIA patients after IAS.MethodsTwenty seven patients of JIA and equal number of age and sex matched healthy controls were enrolled. Thirty six knee joints were injected with IAS. Duration of morning stiffness, swelling score, tenderness score, range of motion, visual analogue scale for pain, Physician global assessment of disease activity, Patient/Parent assessment of general well being, Juvenile Arthritis Disease Activity Score, erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), synovial thickness, synovial effusion, Color fraction (CF) and Resistive index (RI) were measured at base line and at one and two months of follow-up.ResultsAt baseline, a significant difference was found in ESR, CRP, CF and RI values between cases and controls. A significant decrease in various clinical, core set variables and ultrasonographic parameters was observed at each follow-up. Synovial thickness, synovial effusion and CF decreased by 51.78%, 64.67% and 49.35% respectively and range of motion and RI increased by 166% and 31.94% respectively at second follow-up. Both CF and RI showed a significant correlation with active joint count. Both CF and RI had a high inter and intra-class correlation.ConclusionsPower Color Doppler and Spectral Doppler ultrasonographic indices (CF and RI) may have a role in assessment of the response to IAS injection of inflamed knee joints.

Isolated tuberculous liver abscess in a 3-year-old immunocompetent child

Abstract Tuberculous liver abscess without active pulmonary or miliary tuberculosis or other clinical evidence of tuberculosis, is very rare. A 3-year-old immunocompetent boy with isolated tuberculous liver abscess recovered completely on systemic anti-tuberculous drugs.

Henoch Schonlein Purpura Mimicking Lupus Nephritis-A Rare Case -

Introduction Henoch Schonlien Purpura(HSP ),the most common non granulomatous ,immune complex mediated small vessel vasculitis in children involves multiple organs [1–2]. In adults and infants less than 2 years it tends to have an atypical course with higher rate of gastrointestinal and renal complications [1]. HSP nephritis is reported to occur in 20-80% of patients and characterized by mesangial or mesangioproliferative glomerulonephritis with varying degree of hypercelullarity Rapidly progressive glomerulonephritis is rare in children with HSP. One to seven percent patients suffer from end stage renal disease [3,4]. On Imunofluoroscence renal biopsy shows, predominantly granular deposits of IgA in the mesangium and to a lesser extent IgG or IgM deposits [5]. Full house on inmmunofluorosence is the term given to the characteristic histological findings in lupus nephritis which include glomerular deposits of IgG, IgM, IgA, C3, C4 and C1q [6]. We report a case of HSP who presented with edema over dorsum of hands and feet, arthritis and immune complex mediated rapidly progressive nephritis with full house picture on immunofluoroscencea rare occurrence. Abstract

Pseudotumour cerebri with multiple cranial nerve palsies in enteric fever.

To the Editor: A 7-y-old boy presented with high grade fever for 8 d along with headache and vomiting for last 3 d. His examination revealed pulse rate of 100/min, respiratory rate of 28/min, blood pressure of 100/70 mm Hg, weight of 22 kg, body mass index of 22.6 kg/m and hepatosplenomegaly. Examination of other systems was unremarkable. Investigations revealed hemoglobin of 10.1 g% and total leukocyte counts of 8,000/mm (polymorphs 75 %, lymphocytes 25 %). Kidney function tests, liver function tests, thyroid function tests were normal and malaria card test was negative. Salmonella typhi was grown in blood culture and widal test titres were 1/480 (both To and TH). Ultrasonography revealed hepatosplenomegaly. Patient was started on intravenous ceftriaxone. As fever and headache still persisted on fifth day of treatment, azithromycin was added [1]. On eighth day of therapy he developed diplopia with continued headache, bilateral 6th nerve palsy, left sided facial nerve palsy, brisk deep tendon reflexes along with bilateral ankle clonus. Child was conscious and had no meningeal signs. He had bilateral papilledema with normal vision and normal pupillary reflexes (Fig. 1). Computed tomography and Magnetic resonance imaging of brain and brainstem were normal. A provisional diagnosis of pseudotumour cerebri was made. Lumbar puncture was done which revealed CSF opening pressure of 228 mm H2O with normal cell counts, sugar and protein. Intravenous mannitol, acetazolamide and glycerol were started. After 5 d of therapy, headache, papilloedema, bilateral 6th nerve and facial nerve palsies persisted and therefore prednisolone was added (2 mg/kg/d). His headache improved in next two days, facial nerve palsy recovered completely over next four days but abducent nerve palsy and papilledema persisted. Patient was discharged on prednisolone, acetazolamide and glycerol. These medications were given for 2 wk and prednisolone was then tapered off and stopped over another 2 wk .On follow up at 2 mo patient’s fundus examination was normal and 6th nerve palsy had recovered completely (Fig. 2). The neurological complications of typhoid fever include encephalopathy, encephalitis, meningitis, cerebellar

Pure Red Cell Aplasia in a Three-Months-Old Infant Possibly Secondary to Cytomegalo Virus Infection

We report a 3 months old child who presented with severe anemia due to pure red cell aplasia (PRCA). After ruling out other known causes of PRCA, congenital cytomegalovirus (CMV) infection was diagnosed to be the cause. The child responded to Ganciclovir and is doing well. CMV infection should be considered as differential diagnosis in PRCA during infancy.