Pub Date : 2022-01-01DOI: 10.7199/ped.oncall.2022.45
M. Shinde, Anilkumar M. Khamkar, Pralhad D Pote, Pradeep Suryawanshi
During this covid-19 pandemic, a few cases of vertical transmission of severe acute respiratory syndrome coronavirus-2 from mothers to the fetus have been documented. Anti-SARS CoV-2 antibodies mediated multisystem inflammatory response syndrome (MIS-C) is known phenomenon in children. With this case report, we aim to demonstrate the evidence of fetal inflammatory response syndrome (FIRS) associated with anti-SARS CoV-2 antibodies in a premature neonate presenting with respiratory distress, seizures and shock in initial hours of life. The infant was RTPCR negative for covid-19, but positive for anti-SARS CoV-2 antibodies with raised inflammatory markers, suggestive of systemic inflammatory response syndrome. A comprehensive workup for other infectious pathogens also came up negative. Baby received IvIg and steroids and recovered completely. We believe that this systemic inflammation occurred due to antenatal exposure to the covid-19 virus and that more such instances will emerge in future. Introduction In current times, COVID-19, caused by SARS-CoV-2, has been a global public health crisis. The disease severity is less in neonates and young children for certain reasons .1 But recent reports of multisystem inflammatory syndrome in children, MIS-C, have been described by Kathleen M et al and Shreepal J et al.2,3 The specific mechanism is unknown, although it is thought to be related to immunological dysregulation caused by SARS CoV2 infection.4 The disease manifests as persistent high grade fever and multisystem involvement with raised inflammatory markers and requiring PICU management]2. The disease simulates Kawasaki disease and cytokine storm as in adults. Majority of the children are positive for anti SARS CoV2 antibodies while less number of kids are RTPCR positive.2 Unlike MIS-C, where SARSCoV-2 infection and multisystem inflammation occur in the same subject, a few case reports suggest neonatal multisystem inflammation occurs secondary to maternal SARS-CoV-2 infection.5,6 Here we report a case of a newborn with very high SARS CoV-2 antibodies titre and elevated inflammatory markers who presented as multi systemic inflammation also known as fetal inflammatory response syndrome within the first few hours of life. Case Report A 26 years old primigravida went into spontaneous labour at 32 weeks of gestation and a male neonate (birth weight 1474 grams) was delivered by vaginal delivery in a private nursing home at Pune, Maharashtra, India. Baby cried immediately at birth and did not require resuscitation (APGAR score 8 at 1 minute, 10 at 5 minutes) but within 30 minutes developed grunting and respiratory distress. Baby was then shifted urgently in a tertiary care NICU at Pune, Maharashtra, India, under standard transportation protocol in neonatal ambulance. Baby was initially placed on CPAP with a PEEP of 6 and a FiO2 of 30 percent, but due to her increasing work of breathing, baby was intubated and given positive pressure ventilation. Initial AB
{"title":"Fetal Inflammatory Response Syndrome Associated With SARS-CoV-2 Exposure In Utero","authors":"M. Shinde, Anilkumar M. Khamkar, Pralhad D Pote, Pradeep Suryawanshi","doi":"10.7199/ped.oncall.2022.45","DOIUrl":"https://doi.org/10.7199/ped.oncall.2022.45","url":null,"abstract":"During this covid-19 pandemic, a few cases of vertical transmission of severe acute respiratory syndrome coronavirus-2 from mothers to the fetus have been documented. Anti-SARS CoV-2 antibodies mediated multisystem inflammatory response syndrome (MIS-C) is known phenomenon in children. With this case report, we aim to demonstrate the evidence of fetal inflammatory response syndrome (FIRS) associated with anti-SARS CoV-2 antibodies in a premature neonate presenting with respiratory distress, seizures and shock in initial hours of life. The infant was RTPCR negative for covid-19, but positive for anti-SARS CoV-2 antibodies with raised inflammatory markers, suggestive of systemic inflammatory response syndrome. A comprehensive workup for other infectious pathogens also came up negative. Baby received IvIg and steroids and recovered completely. We believe that this systemic inflammation occurred due to antenatal exposure to the covid-19 virus and that more such instances will emerge in future. Introduction In current times, COVID-19, caused by SARS-CoV-2, has been a global public health crisis. The disease severity is less in neonates and young children for certain reasons .1 But recent reports of multisystem inflammatory syndrome in children, MIS-C, have been described by Kathleen M et al and Shreepal J et al.2,3 The specific mechanism is unknown, although it is thought to be related to immunological dysregulation caused by SARS CoV2 infection.4 The disease manifests as persistent high grade fever and multisystem involvement with raised inflammatory markers and requiring PICU management]2. The disease simulates Kawasaki disease and cytokine storm as in adults. Majority of the children are positive for anti SARS CoV2 antibodies while less number of kids are RTPCR positive.2 Unlike MIS-C, where SARSCoV-2 infection and multisystem inflammation occur in the same subject, a few case reports suggest neonatal multisystem inflammation occurs secondary to maternal SARS-CoV-2 infection.5,6 Here we report a case of a newborn with very high SARS CoV-2 antibodies titre and elevated inflammatory markers who presented as multi systemic inflammation also known as fetal inflammatory response syndrome within the first few hours of life. Case Report A 26 years old primigravida went into spontaneous labour at 32 weeks of gestation and a male neonate (birth weight 1474 grams) was delivered by vaginal delivery in a private nursing home at Pune, Maharashtra, India. Baby cried immediately at birth and did not require resuscitation (APGAR score 8 at 1 minute, 10 at 5 minutes) but within 30 minutes developed grunting and respiratory distress. Baby was then shifted urgently in a tertiary care NICU at Pune, Maharashtra, India, under standard transportation protocol in neonatal ambulance. Baby was initially placed on CPAP with a PEEP of 6 and a FiO2 of 30 percent, but due to her increasing work of breathing, baby was intubated and given positive pressure ventilation. Initial AB","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"29 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"87756626","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/ped.oncall.2024.3
Meryem El-bouz, Halima Msaaf, L. Aoued, W. Gueddari
Pseudotumour cerebri may be idiopathic or secondary. Clinicians must take care to exclude secondary causes of raised intracranial pressure in all patients. We report a case that illustrates the importance of asking about dietary intake and supplements when evaluating a patient with pseudotumour cerebri.
{"title":"Rare cause of pseudotumor cerebri in children","authors":"Meryem El-bouz, Halima Msaaf, L. Aoued, W. Gueddari","doi":"10.7199/ped.oncall.2024.3","DOIUrl":"https://doi.org/10.7199/ped.oncall.2024.3","url":null,"abstract":"Pseudotumour cerebri may be idiopathic or secondary. Clinicians must take care to exclude secondary causes of raised intracranial pressure in all patients. We report a case that illustrates the importance of asking about dietary intake and supplements when evaluating a patient with pseudotumour cerebri.","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77504192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/ped.oncall.2022.29
Ana Rita de Matos Ramos, Isabel Maria do Amaral Rodeia Rodrigues de Brito, M. Almeida, Jose Paulo Alves Pinheiro Calhau
{"title":"Pelvic pyomyositis and abscess of the internal obturator muscle: case successfully managed with conservative treatment","authors":"Ana Rita de Matos Ramos, Isabel Maria do Amaral Rodeia Rodrigues de Brito, M. Almeida, Jose Paulo Alves Pinheiro Calhau","doi":"10.7199/ped.oncall.2022.29","DOIUrl":"https://doi.org/10.7199/ped.oncall.2022.29","url":null,"abstract":"","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"33 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"82727169","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/ped.oncall.2022.43
Ana Rita de Matos Ramos, Odete R Mingas, Maria Filomena Cardosa, Maria da Graca Gomes Cantante Nogueira dos Santos, L. M. Abecasis
{"title":"Congenital midline malformation in a newborn","authors":"Ana Rita de Matos Ramos, Odete R Mingas, Maria Filomena Cardosa, Maria da Graca Gomes Cantante Nogueira dos Santos, L. M. Abecasis","doi":"10.7199/ped.oncall.2022.43","DOIUrl":"https://doi.org/10.7199/ped.oncall.2022.43","url":null,"abstract":"","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"168 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79636011","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/PED.ONCALL.2022.33
J. Kathwate
Lymphadenitis is common in primary Tuberculosis (TB) in children and they may be asymptomatic during the non-suppurative lymphadenitis phase. Intrathoracic nodes may compress one of the bronchus leading to atelectasis, lung infection and bronchiectasis or thoracic duct leading to chylous effusion. Other intrathoracic complications include dysphagia, oesophago-mediastinal fistula, tracheo-oesophageal fistula, biliary obstruction and cardiac tamponade. Though mediastinal tubercular lymphadenitis (MTL) is common in developing countries ,encasement of aorta by it is extremely rare. We report an eightyear-old girl who presented with non-healing right axillary lymphadenitis, later diagnosed to have MTL and found to have complete aortic encasement. Introduction Lymphadenitis is the most common extrapulmonary manifestation of tuberculosis (TB) accounting for 35% of cases.1 It is generally characterized by conglomerates, localized in multiple sites mostly in the right paratracheal, hilar and subcarinal areas, with an inhomogeneous CT enhancement pattern and associated with lung infiltrate in 90% of cases.2 Tuberculous involvement of the ascending aorta is rare, even in a country like India where the burden of TB is enormous, and here we have reported a case of complete encasement of aorta by enlarged MTL which is a first report of an ascending aortic encasement. Case Report An 8-year-old girl presented with non-healing right axillary abscess with persistent discharging for 6 months. She was on anti-tuberculous therapy (ATT) for 10 months as she was detected to have primary complex on chest X-ray with positive tuberculin skin test (TST) and fever. After one month of ATT, she developed pericardial effusion with tamponade requiring pericardiocentesis. She also had bilateral pleural effusion and ascites. Pericardial fluid did not grow any organism on culture and TB culture was also negative. Her ATT had been continued and steroids were added. After 5 months of ATT, she developed a right axillary cold abscess. Incision and drainage were done and streptomycin and linezolid were added. The smear showed presence of acid-fast bacilli (AFB). Streptomycin was stopped within a month and amikacin and levofloxacin was started which was given for 3 months. Echocardiography was repeated which was normal. On presentation to us, her weight was 16.6 kg, she had pallor and persistent discharging sinus in the right axilla. Blood pressure in upper limbs were 90/40 mm of Hg and that in lower limbs were 120/60 mm of Hg. On systemic examination, she had a systolic murmur at the apex. Other systems were normal. A repeat echocardiography showed solidified collection in the superior mediastinum completing encasing aorta and main pulmonary artery causing constriction with a peak gradient of 23 mm of Hg across it. CT chest showed patchy areas of consolidation in apical segment of right upper lobe and lower lobe and nodular opacities in adjacent lung with localized pleural effusion, pl
{"title":"Mediastinal tubercular lymph nodes completely encasing aorta in a child- A rare complication","authors":"J. Kathwate","doi":"10.7199/PED.ONCALL.2022.33","DOIUrl":"https://doi.org/10.7199/PED.ONCALL.2022.33","url":null,"abstract":"Lymphadenitis is common in primary Tuberculosis (TB) in children and they may be asymptomatic during the non-suppurative lymphadenitis phase. Intrathoracic nodes may compress one of the bronchus leading to atelectasis, lung infection and bronchiectasis or thoracic duct leading to chylous effusion. Other intrathoracic complications include dysphagia, oesophago-mediastinal fistula, tracheo-oesophageal fistula, biliary obstruction and cardiac tamponade. Though mediastinal tubercular lymphadenitis (MTL) is common in developing countries ,encasement of aorta by it is extremely rare. We report an eightyear-old girl who presented with non-healing right axillary lymphadenitis, later diagnosed to have MTL and found to have complete aortic encasement. Introduction Lymphadenitis is the most common extrapulmonary manifestation of tuberculosis (TB) accounting for 35% of cases.1 It is generally characterized by conglomerates, localized in multiple sites mostly in the right paratracheal, hilar and subcarinal areas, with an inhomogeneous CT enhancement pattern and associated with lung infiltrate in 90% of cases.2 Tuberculous involvement of the ascending aorta is rare, even in a country like India where the burden of TB is enormous, and here we have reported a case of complete encasement of aorta by enlarged MTL which is a first report of an ascending aortic encasement. Case Report An 8-year-old girl presented with non-healing right axillary abscess with persistent discharging for 6 months. She was on anti-tuberculous therapy (ATT) for 10 months as she was detected to have primary complex on chest X-ray with positive tuberculin skin test (TST) and fever. After one month of ATT, she developed pericardial effusion with tamponade requiring pericardiocentesis. She also had bilateral pleural effusion and ascites. Pericardial fluid did not grow any organism on culture and TB culture was also negative. Her ATT had been continued and steroids were added. After 5 months of ATT, she developed a right axillary cold abscess. Incision and drainage were done and streptomycin and linezolid were added. The smear showed presence of acid-fast bacilli (AFB). Streptomycin was stopped within a month and amikacin and levofloxacin was started which was given for 3 months. Echocardiography was repeated which was normal. On presentation to us, her weight was 16.6 kg, she had pallor and persistent discharging sinus in the right axilla. Blood pressure in upper limbs were 90/40 mm of Hg and that in lower limbs were 120/60 mm of Hg. On systemic examination, she had a systolic murmur at the apex. Other systems were normal. A repeat echocardiography showed solidified collection in the superior mediastinum completing encasing aorta and main pulmonary artery causing constriction with a peak gradient of 23 mm of Hg across it. CT chest showed patchy areas of consolidation in apical segment of right upper lobe and lower lobe and nodular opacities in adjacent lung with localized pleural effusion, pl","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"98 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"74253192","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/PED.ONCALL.2022.24
H. Gala
{"title":"Fulminant Hepatic Failure in a Child with Fever and Jaundice","authors":"H. Gala","doi":"10.7199/PED.ONCALL.2022.24","DOIUrl":"https://doi.org/10.7199/PED.ONCALL.2022.24","url":null,"abstract":"","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"77 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89089300","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Pub Date : 2022-01-01DOI: 10.7199/PED.ONCALL.2022.51
Harshal Dhabe, A. Goyal, Saket R. Sanghai
{"title":"Clinical Profile of Liver Abscess In Children","authors":"Harshal Dhabe, A. Goyal, Saket R. Sanghai","doi":"10.7199/PED.ONCALL.2022.51","DOIUrl":"https://doi.org/10.7199/PED.ONCALL.2022.51","url":null,"abstract":"","PeriodicalId":19949,"journal":{"name":"Pediatric Oncall","volume":"26 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2022-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73089833","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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