Introduction. Pneumonia is a common infectious disease among children, very familiar to pediatricians and a major cause of hospitalization worldwide. Mycoplasma pneumoniae (M. pneumoniae) - atypical ...pathogen, is estimated to be responsible for approximately 30-40% of community-acquired pneumonias. The aim of the paper was to underline the diagnostic and treatment difficulties in a case of pneumonia with M. pneumoniae in a school-aged boy, with multiple presentations in the Emergency Service for respiratory difficulties. Material and method. We present the case of a 7 years and 10-month-old male patient, admitted to our clinic for wheezing, cough and dyspnea. Results. The clinical exam at admission pointed out influenced general status, wheezing, thoraco-abdominal swing, intercostal draft, sibilant and crackles, oxygen saturation 89%, tachycardia 134 beats/minute. The blood tests revealed mild leukocytosis, with neutrophilia, slightly increased inflammatory biomarkers. Considering the general status and the presence of functional respiratory syndrome, steroid and symptomatic anti-inflammatory treatment is initiated. However, the general condition remains stable, which required the widening of the spectrum of investigations with the performance of a chest CT noticing a pneumonic condensation with an air bronchogram located at the level of the right upper lobe. Considering the stationary respiratory functional syndrome and the radiological appearance of the pneumonia as well as the age, we performed serology for atypical germs and identified a positive titer of Ig M antibodies for M. pneumoniae by instituting Azithromycin po., but after 3 days, the evolution remains stationary, thus we changed the treatment with intravenous Levofloxacin, with a favorable subsequent evolution. Conclusions. Pneumonia with atypical pathogens such as M. pneumoniae is a well-defined and well-known pathology in the literature, but it still remains a condition that imposes multiple difficulties related to the diagnosis and therapeutic management of pediatric cases.
Introduction. Hepatitis A is the most common cause of acute hepatitis in children. Wilson disease (WD) is a rare autosomal recessive condition that can result in chronic liver disease. Hepatitis A ...may be a trigger in the onset of WD. Case presentation. We report the case of a previously healthy 7-year-old girl, admitted in our clinic for upper digestive hemorrhage, jaundice and increased abdomen in volume. The onset of the disease was 1 month before when she was diagnosed with hepatitis A. The laboratory tests at the time of admission pointed out anemia, increased inflammatory biomarkers, conjugated hyperbilirubinemia, hypoalbuminemia, hepatic cytolysis, elevated alkaline phosphatase levels, hyponatremia, and severe coagulopathy. The abdominal ultrasound showed hepatomegaly, inhomogeneous structure, granular echogenicity, with micronodules, diameter of the portal vein 9 mm, altered portal vein pulsatility, splenomegaly and ascites. The upper digestive endoscopy revealed hyperemia and edema of the gastric mucosa, adherent gastric clots, incipient varices of the gastric fornix. The echocardiography showed mild pleural and pericardial effusion. We ruled out hepatitis B, hepatitis C, toxoplasma, rubella, herpes virus, Epstein Barr virus, cytomegalovirus, but also autoimmune hepatitis. Based on the low levels of ceruloplasmin and serum copper, and the positive D-penicilamine test associated to gastric varices and portal hypertension, we established the diagnosis of WD. The ophthalmology and neurological consults found no pathological changes. The patient’s clinical and biochemical evolution was favorable after the initiation of chelation therapy. Conclusion. Though rare, the association between hepatitis A and WD can result in acute liver failure and death, especially in previously healthy children.
Introduction. The incidence of obesity reached alarming rated in pediatric population resulting in a global public health problem. The aim of our study consists of the assessment of anthropometric ...and laboratory parameters in obese children. Material and method. We performed a retrospective observational study on 155 children, with the age between 5 and 17 years admitted in the Pediatrics Clinic 1 Tg. Mures, who were divided according to BMI in: group I – 65 children with a BMI over percentile (P) 95; group II – 90 children with normal BMI, between P5 and P85. Results. The mean age of the obese children was significantly higher as compared to normal weight ones (p = 0.0007). Parental weight was significantly higher in obese children in comparison to normal weight ones (p = 0.0074, p = 0.0062). Anthropometric parameters had significantly higher values in group I as compared to group II (p < 0.0001). Most of CBC parameters had significantly higher levels in children with obesity, except for hemoglobin. T Chol, LDL and TG levels were also significantly higher in obese children as compared to those from control group (p = 0.0229 / p = 0.0049 / p = 0.0058), while HDL was significantly higher in normal weight children (p = 0.0419). AST and ALT presented significantly elevated levels in case of group I (p = 0.0045 / p < 0.0001). Conclusions. The incidence of obesity in small ages is increasing. Anthropometric and laboratory parameters might represent accurate indicators of obesity in children.
Celiac disease (CD) is an immune mediated disorder triggered by gluten diet genetically susceptible individuals. Celiac crisis is a rare but potentially lethal condition that can occur in a ...previously known celiac disease or as its first manifestation. Case presentation. 15-year-old teenager, with a personal history of anemia for which he did not receive proper treatment, was admitted for semi-loose and steatorrheic stools, weight decrease, loss of appetite, fatigability, drowsiness, from approximately 10 days. The laboratory tests performed at the time of admission showed the following: thrombocytosis, iron deficiency anemia, slight increase of transaminases, mixed hyperbilirubinemia with the predominance of indirect bilirubin, and hyponatremia. We ruled out a potential infectious etiology, and the serology markers for celiac disease were positive. Thus, the diagnosis of celiac crisis has been established as the onset form of celiac disease based on the symptoms, increased anti-transglutaminase (> 10x normal value) and anti-endomysium antibodies. During admission, we administered symptomatic treatment, fluids by vein, and we initiated the gluten-free diet. Three months after the initiation of the gluten-free diet, the patient’s clinical course was favorable and the laboratory tests improved considerably: with negative anti-endomysium antibodies and marked decrease in anti-transglutaminase antibodies value. Conclusions. The celiac crisis should be taken into account in the differential diagnosis of all patients with sudden onset diarrhea, metabolic disorders and weight loss after an infectious etiology has been ruled out, and its recognition is important and facilitates prompt treatment.
Introducere. Hepatita A este cea mai frecventă cauză de hepatită acută la copii. Boala Wilson (BW) este o patologie autozomal recesivă rară care poate duce la hepatopatie cronică. Hepatita A poate ...reprezenta un trigger pentru debutul BW. Prezentare de caz. Prezentăm cazul unei paciente în vârstă de 7 ani, fără antecedente personale patologice semnificative, internată în clinica noastră pentru hemoragie digestivă superioară, icter și distensie abdominală. Debutul bolii a fost cu 1 lună anterior internării când a fost diagnosticată cu hepatită A. Analizele de laborator la momentul internării au arătat anemie, reactanți de fază acută pozitivi, hiperbilirubinemie directă, citoliză hepatică, nivel seric crescut al fosfatazei alcaline, hiponatremie și coagulopatie severă. Ecografia abdominală a pus în evidență hepatomegalie, ecostructură hepatică inomogenă, ecogenitate granulară, cu micronoduli, diametrul venei porte de 9 mm, pulsatilitate alterată a venei porte, splenomegalie și ascită. Endoscopia digestivă superioară a arătat hiperemie și edem la nivelul mucoasei gastrice, cu cheaguri aderente la suprafața mucoasei și varice incipiente la nivelul fornixului gastric. Ecocardiografia a evidențiat colecție pleurală și pericardică în cantitate mică. Am exclus hepatita B și C, toxoplasma, rubeola, herpes virus, virusul Epstein Barr, citomegalovirusul și hepatita autoimună. Pe baza nivelurilor scăzute ale ceruloplasminei și cuprului seric, asociate cu testul pozitiv la D-penicilamină, împreună cu varicele gastrice și hipertensiunea portală, am stabilit diagnosticul de BW. Consultul oftalmologic și cel neurologic au fost în relații normale. Evoluția clinică și cea paraclinică a pacientei au fost favorabile după inițierea terapiei chelatoare. Concluzii. Cu toate că este rară, asocierea dintre hepatita A și BW poate duce la insuficiență hepatică acută și deces, în special la copiii fără antecedente patologice.
Introducere. Incidenţa obezităţii a crescut alarmant la populaţia pediatrică, ajungând să reprezinte o problemă de sănătate publică globală. Scopul studiului nostru constă în evaluarea parametrilor ...antropometrici şi de laborator la copiii obezi. Material şi metodă. Am efectuat un studiu retrospectiv observaţional pe 155 de copii, cu vârste între 5 şi 17 ani, internaţi în Clinica Pediatrie I Tg. Mureş, care au fost ulterior împărţiţi în funcţie de IMC în: lotul I – 65 de copii cu IMC peste percentila (P) 95; lotul II – 90 de copii cu IMC normal, între P5 şi P85. Rezultate. Vârsta medie a copiilor obezi a fost semnificativ mai mică decât cea a celor normoponderali (p = 0,0007). Greutatea părinţilor este semnificativ mai mare în cazul copiilor obezi, spre deosebire de cei normoponderali (p = 0,0074, p = 0,0062). Parametrii antropometrici au avut valori semnificativ mai mari la copiii obezi comparativ cu cei normoponderali (p < 0,0001). Majoritatea parametrilor HLG au fost semnificativ mai mari la copiii obezi comparativ cu cei normoponderali, exceptând hemoglobina. Col T, LDL şi TG au fost semnificativ mai mari la copiii obezi comparativ cu cei normoponderali (p = 0,0229 / p = 0,0049 / p = 0,0058), iar HDL a fost semnificativ mai mare în cazul copiilor cu greutate normală (p = 0,0419). AST şi ALT au avut valori semnificativ mai mari la lotul de studiu (p = 0,0045 / p < 0,0001). Concluzii. Incidenţa obezităţii la vârstele mici este în creştere. Parametrii antropometrici şi de laborator pot fi indici fideli ai obezităţii la copil.
Introduction. Approximately 12 million children die every year in developing countries and one third of these deaths are caused by pneumonias. The assessment of radiological changes in dynamics owns ...a major role in establishing the diagnosis of staphylococcal pneumonia. The aim of this paper was to underline the diagnostic and treatment difficulties in a child with staphylococcal pneumonia. Case report. We present the case of a 2 years and 6-month-old male patient admitted in our clinic for hyperpyrexia, productive cough, rhinorrhea and anorexia. The clinical exam at admission pointed out influenced general status, pale ailing face, pallor, fever, productive cough, rhinorrhea, diminished breath sound on the right side, oxygen saturation 97% and anorexia, while de blood tests revealed severe leukocytosis with neutrophilia, anemia, and severely increased inflammatory biomarkers. The chest X-ray showed an opacity within the right inferior lobe. The blood culture was negative. We initiated symptomatic and antibiotic treatment (Ceftriaxone), but due to the unfavorable evolution, the control chest X-ray showed a consolidation area within the right inferior lobe and secluded basal pleural effusion as well as on the right lateral side. We performed also a chest computed tomography (CT), noticing a pneumonic process within two segments of the inferior right lobe, several grouped pneumatocele below the pleura, associating within both lungs areas of lobular hyperinflation. Thus, we raised the suspicion of staphylococcal pneumonia, and we initiated Vancomycin by vein, with favorable evolution. Conclusions. Staphylococcal pneumonia is a well-defined and described pathology in the literature, but still remains a contemporary pathology imposing multiple difficulties related to the diagnosis and management in pediatric patients.
Introduction. Kawasaki disease (KD) and pediatric inflammatory multisystem syndrome (PIMS) are similar vasculitis conditions affecting medium and small vessels, particularly the coronary arteries. ...This study aimed to highlight diagnostic and treatment challenges in a case initially diagnosed as PIMS, which evolved into atypical KD. Materials and methods. A 2-year-10-month-old male was admitted with a high fever persisting for 6 days, unresponsive to antipyretics. Results. On admission, the patient exhibited a poor general condition, pale skin, non-pruritic erythematous rash, and enlarged, non-painful lymph nodes. Laboratory tests showed elevated inflammatory markers, leukocytosis with neutrophilia, hypoalbuminemia, liver enzyme abnormalities, altered cardiac markers, and elevated D-dimers, but no initial echocardiographic changes. Positive SARS-CoV-2 antibodies led to an initial PIMS diagnosis, and treatment with intravenous methylprednisolone, antiplatelet, anticoagulant therapy, and hepatoprotective agents was started. The patient’s condition initially improved but then worsened with febrile spikes, rash, neutropenia, thrombocytopenia, anemia, and coronary artery dilation on echocardiography. This led to a diagnosis of KD with atypical onset, and treatment with immunoglobulin, antiplatelet, and anticoagulant therapy was initiated. The patient’s condition improved slowly. Conclusions. KD and PIMS share overlapping characteristics, making them difficult to distinguish. There is no definitive criterion to differentiate KD and PIMS, leading to potential diagnostic errors.
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