Mariana COSTIN, Eliza CINTEZA and Mihaela BALGRADEAN

ABSTRACT

Introduction: Typical hemolytic uremic syndrome (HUS) is a leading cause of community acquired acute kidney injury in infants and young children. It is defined as a triad of microangiopathic hemolytic anemia, thrombocytopenia and renal insufficiency associated with Shiga toxin-producing Escherichia coli. In this case of HUS that we are going to present, hemolytic anemia and trombocitopenia were the major features, while renal involvement was less important.
Case report: We report the case of a one-year-old Caucasian girl, without significant medical history, who was found to have stool culture with positive enteropathogenic Escherichia coli after an episode of diarrhea. The particularity of this case is that, even if the patient had prodromal diarrhea, thrombocytopenia and anemia in evolution, and the clinical features were consistent with typical HUS diagnosis, other diagnoses were considered due to the lack of apparent renal dysfunction.
Conclusion: Our patient presented some, but not all, abnormalities seen in typical HUS, making it difficult to establish the final diagnosis. Providers must keep in mind to raise the suspicion of typical HUS diagnosis even when some symptoms are missing, in order to establish a correct diagnosis and initiate supportive care.
Keywords: minimal renal involvement, Escherichia coli O26, HUS differential diagnosis

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Nicoleta Aurelia POPESCU, Marcela Daniela IONESCU, Georgiana BALAN, Simina VISAN, Eliza CINTEZA, Diana STANESCU, Ionut GOBEJ and Mihaela BALGRADEAN

ABSTRACT

Central sleep apnea is characterized by frequent cessation of breathing during sleep, resulting in repetitive episodes of insufficient ventilation and abnormalities of acid-base balance. It may be primary or secondary, and it is uncommon in children, with limited data for this population.
We present here the case of a five-year-old girl, known to have thoracolumbar myelomeningocele (for which she underwent a surgical procedure in infancy), secondary hydrocephalus (with a ventriculoperitoneal shunt) and flaccid paralysis, who was admitted in our hospital with prolonged fever syndrome, productive cough, severe dyspnea and perioral cyanosis. Following physical examination, laboratory investigations and thoracic radiography, we established the diagnosis of aspiration pneumonia with acute respiratory failure. Medical treatment with multiple systemic antibiotics, antifungal agents, systemic and inhaled bronchodilator, oxygen therapy and respiratory nursing were initiated, with favorable evolution.
During the entire hospitalization, the patient showed nocturnal respiratory rhythm disorders, with sleep apnea crisis of approximately 20 seconds and desaturation, followed by severe hypercapnic respiratory acidosis, manifestations that persisted even after the remission of pulmonary infection, raising the suspicion of an apnea syndrome. After excluding the causes of obstructive apnea, a cerebral CT scan was performed, revealing isolated fourth ventricle compressing the brainstem. The patient underwent neurosurgical intervention and postoperatively, the evolution was favorable, with remission of apnea crisis.
Keywords: central sleep apnea, isolated fourth ventricle, myelomeningocele, hypercapnia, child.

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Eliza CINTEZA, Claudiu STOICESCU, Niculina BUTOIANU, Mihaela BALGRADEAN, Alin NICOLESCU and Matthias ANGRÉS

ABSTRACT

Heart implication in Duchenne muscular dystrophy usually is present in the form of dilated cardiomyopathy, manifested as heart failure and arrhythmias. To delay progression, including heart deterioration, prednisone is recommended as preventive treatment. We report the case of an 11-year-old boy diagnosed with Duchenne muscular dystrophy at the age of seven, who was on preventive treatment with oral prednisone (0.75 mg/kg/day) and beta blocker (metoprolol, 1 mg/kg/day). Suddenly, the patient presented acute chest pain, vomiting and sweating. The electrocardiogram showed ST elevation in inferior leads. Troponin T was increased to 30814 pg/ml (normal values <14 pg/mL). The echocardiography revealed reduced contractility of the posteroinferior wall of the left ventricle. After excluding coronary implications by coronary angiography, we increased the oral prednisone to 1.4 mg/kg/day for five days and added enalapril (0.5 mg/kg/day, po). The response was positive, with a rapid decrease of the troponin T value to 3186 pg/mL in five days and gradual recovery of myocardial contractility afterwards.
Keywords: acute myocardial injury, Duchenne muscular dystrophy, oral pulse steroid therapy.

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Doina Anca PLESCA, Monica LUMINOS, Luminita SPATARIU, Mihaela STEFANESCU, Eliza CINTEZA and Mihaela BALGRADEAN

ABSTRACT

Postinfectious arthritis is a relatively often encountered in pediatric practice. The authors present the most important data concerneing this pathology, with up to date informations exemplifying with case presentations. Clinical cases bring to attention the most common forms of postinfectious arthritis (reactive arthritis, postinfectious arthritis bacterial, viral, spirochete, and so on). Although highly studied and commonly found in current pediatric practice, arthritis occurring after infections remains controversial entities, especially regarding terminology. While, according to some authors, postinfectious arthritis belongs to the large group of reactive arthritis, by other authors, these joint events are independent entities.

Keywords: arthritis, postinfectious arthritis, child

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Georgiana NICOLAE, Alin NICOLESCU, Ana-Maria VINTILA, Adriana DIACONU, Andreea ANDRONACHE, Gabriela DUICA, Eliza CINTEZA and Cristina FILIP

ABSTRACT

Infective endocarditis is rare in children and is rarer on a normal structural heart in an infant without any surgical intervention. Most cases are related to a pre-existing congenital lesion, the most frequent etiology are Gram-positive cocci and the most feared are fungal agents. This report presents a 7-month-old infant with fungal endocarditis on a normal structural heart. The diagnosis was suspected on clinical examination and was confirmed by echocardiography and positive blood cultures. His particular clinical evolution after medical and surgical treatment illustrates a severe disease with poor prognosis which may be a complication of neonatal intensive care procedures.
Unusual cause of fungal endocarditis in a previously healthy infant: neonatal hospitalization in intensive care unit.

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