Zainab F Ibrahim

Supernumerary clavicles with multiple skeletal malformations in an unusual association

The clavicle is one of the earliest bones to ossify in utero. Their associated malformations are uncommon. The most common among them is pseudoarthrosis of the clavicle. However, the supernumerary clavicle is a rarity. It is often isolated, unilateral, and an accidental finding seen at adult age because it is asymptomatic; however, the case of a 3-month-old girl which was diagnosed much earlier because she had other associated malformations is reported.

Is this 4-year-old female child suffering from a forme fruste of hypomelanosis of Ito?

Hypomelanosis of ito (HI) is a multisystemic disorder characterized by cutaneous, neurologic disorder, and musculoskeletal disorder. However, there may be isolated cutaneous manifestation, resulting in diagnostic overlap with other hypopigmentary lesions such as nevus depigmentosus and hypopigmentation along the lines of Blaschko. Therefore, there is the need for generally acceptable diagnostic criteria avoiding these ambiguities. Hence, the case of a 4-year-old female child with isolated hypopigmentations characterized as whorls on the torso and as linear distribution along the lines of Blaschko is reported.

When the skin changes in severe acute malnutrition appear as burns

Majority of the Asian and African children live with malnutrition. About 30% of the children in sub-Saharan Africa have the problem of protein energy malnutrition (PEM), and the eastern African region is the worst hit area of the world. Malnutrition is still of great concern in resource-poor countries, and it accounts for about 50% of under 5-year mortality; this amounts to about 3 million deaths/annum. The United Nations Human Development Index in 2006 estimated that 70.8% of the Nigerian population live on less than one dollar a day, while 92.4% live on less than two dollars a day; this observation, coupled with ignorance, and diseases such as diarrhoea and measles form the perfect cocktail for malnutrition. Serve acute malnutrition (SAM) affects all the body systems including the skin. The exact mechanism of skin change in SAM is not completely understood, but the role of micronutrient deficiencies such as zinc and vitamins cannot be overruled. Heilskov et al. in their study classified the skin changes into basically four groups namely: ‘telogenic effluvium, hyperand hypo-pigmentation, ichthyosiform, lichenoid and bullae-erosion-desquamation changes.’ They further developed a scoring system establishing prognosis from these changes, in which the lichenoid form was associated with the risk of death. However, the cases of mixture of all these skin lesions may also be experienced; therefore, the case of a 12month-old boy, who had mixture of these cutaneous changes with denuded skin appearing as burns, is highlighted in this communication. He was delivered at term in a family of 10 children. Both parents were not educated; the father was a subsistent farmer, while the mother was a stay-at-home mother. He was not exclusively breastfed, and he had a history of recurrent loose stools. Pap-based diet was introduced at the age of 4 months. The mother noticed a progressive poor weight gain, and 2 weeks to presentation, he developed dryness of the skin, which became thickened with increased pigmentation. Five days later, there was an extensive peeling of the skin exposing raw surfaces − affecting the anterior and posterior surfaces of the trunk and upper limbs−which appeared as burns (by estimation, about 60% of the body

Pyrexia of unknown origin: A diagnosis and treatment challenge in a resource-limited setting

The term pyrexia of unknown origin (PUO) was first described by Petersdorf and Beeson in 1961. It is characterized by a temperature of more than 38.3°C on several occasions lasting for more than 3 weeks or for more than 1 week of inpatient investigation. The etiology of PUO is extensive but could be broadly classified into infectious and noninfectious causes. Infection accounts for 34% of cases; the case of a 6-month-old boy who presented with fever of 2 months duration is reported. He had series of investigations without the etiology identified. Furthermore, he was placed on empiric antibiotics on admission but the fever persisted; however, he was discharged after 3 weeks; and while on follow-up visit, the fever resolved. This report highlights how bizarre PUO may present.

Hypoglycemia in a child with tramadol poisoning

Tramadol is a central acting analgesic of the opioid group used for moderate to severe pain. Tramadol overdose can be accidental or intentional and is more common in adolescent and adult males. We report the case of a 4-year-old boy presenting with hypoglycemia following tramadol poisoning with loss of consciousness and convulsion; he was managed conservatively and made remarkable improvement without any sequelae.

Childhood pulmonary tuberculosis with digital clubbing

Tuberculosis is prevalent in the tropics and sub-tropics; late treatment may result in severe morbidity and mortality. Digital clubbing has been associated with several diseases including pulmonary tuberculosis though the exact mechanism is poorly understood; this has been linked mostly with severe adult pulmonary tuberculosis associated with cavitations, hypoalbuminemia and smear-positive sputum, but the case of an 11-year-old boy who presented with digital clubbing and leukonychia with absence of cavitary lesion or hypoalbuminemia is reported.

An unusual startling

Hyperekplexia is a rare movement disorder, which is mostly of genetic origin; though acquired cases are rarely reported. This disorder is characterized by excessive startling response to external stimuli; this can be disenabling, affecting quality-of-life. Furthermore, it can easily be mistaken for an epileptic disorder. Therefore, the case of a 10-year-old boy who presented with excessive startling shortly after been treated for cerebral malaria is reported; the patient responded to carbamazepine and was discharged home afterward.

Cyanotic congenital heart disease: Our constraint in a resource-limited setting

Prevalence of thrombocytopenia in congenital cyanotic heart disease is not known, and decreased platelet production due to right to left shunting of megakaryocytes away from the lung has also been implicated as a possible cause.[4,5] Furthermore, they are prone to infective endocarditis and coupled with right to left shunting of infected thrombi which may embolize to body organs including the brain resulting in cerebral abscess and mycotic aneurysm. His hematocrit still remained high despite the B‐T shunt because the B‐T shunt was now inadequate for his age. Availability of definitive surgery in our setting will certainly improve his quality of life and survival.

Haemolytic anemia and mothball toxicity: A case report

The risk of mothball poisoning is more in developing countries, where there is poor consumer protection; often products are poorly labeled and in most of the cases, consumers do not have product details. Naphthalene containing mothball poisoning may present late with anemia; and in malaria prone environment such as ours, there is tendency of miss-diagnosis, if history of exposure is not sort. Therefore, the case of a 2-year-old boy who presented 48-hours after exposure with severe anemia warranting blood transfusion is reported.

Changing pattern of severe malaria

1. World Health Organization. Fact-Sheet on the World Malaria Report 2013. Available from: http://www.who.int/malaria/ media/world_malaria_report_2013/en/. [Last accessed on 2014 Jul 12]. 2. Makani J, Matuja W, Liyombo E, Snow RW, Marsh K, Warrell DA. Admission diagnosis of cerebral malaria in adults in an endemic area of Tanzania: Implications and clinical description. QJM 2003;96:355-62. 3. Sowunmi A, Walker O, Salako LA. Cerebral malaria in nonpaediatrics subjects resident in southwestern Nigeria. Afr J Med Med Sci 1993;22:49-53. 4. Okubadejo NU, Danesi MA. Diagnostic issues in cerebral malaria: A study of 112 adolescents and adults in Lagos, Nigeria. Niger Postgrad Med J 2004;11:10-4. 5. Ogoina D, Obiako RO. Clinical presentation and outcome of severe malaria in adults in Zaria, Northern Nigeria. Ann Afr Med 2012;11:245-6. 6. Abdallah TM, Abdeen MT, Ahmed IS, Hamdan HZ, Magzoub M, Adam I. Severe Plasmodium falciparum and Plasmodium vivax malaria among adults at Kassala Hospital, eastern Sudan. Malar J 2013;12:148. 7. Akhwale WS, Lum JK, Kaneko A, Eto H, Obonyo C, Björkman A, et al. Anemia and malaria at different altitudes in the western highlands of Kenya. Acta Trop 2004;91:167-75. Sir, About 3.4 billion people are at risk of malaria globally, and of these, 1.2 billion are at high risk. In 2012 there were 207 million cases of malaria reported globally, with an estimated 627,000 deaths, about 90% of which occurred in sub-Saharan Africa.[1] However, in most African countries with an endemic transmission pattern, including Nigeria, cases of severe forms of malaria are rare in the adult population. This is due to protective immunity acquired at a younger age. A few cases of severe malaria have indeed been documented in the adult population,[2,3] which were mostly cerebral malaria in the southern part of this country.[4] Severe malarial anemia is mostly seen in younger children,[5] therefore, its occurrence in an adolescent is worth reporting.