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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Marcela Daniela IONESCU, Nicoleta Aurelia POPESCU, Georgiana BALAN, Veronica MARCU, Augustina ENCULESCU, Lorena VATRA, Marcel OANCEA and Mihaela BALGRADEAN

ABSTRACT

Necrotizing pneumonia remains an uncommon complication of pneumonia in children, but its incidence is increasing. Pneumococcal infection is the predominant cause of severe necrotizing pneumonia in children, but methicillin resistant Staphylococcus aureus (MRSA) and Panton-Valentine leukocidin (PVL) staphylococcal infections are also important.
We present the case of a four-year-old girl,with an unremarkable medical history, who was admitted in our hospital with a history of high fever, productive cough and tachypnea lasting for 10 days, progressive worsening despite empirical oral antibiotic. Following physical examination, laboratory investigations and thoracic radiography, we established the diagnosis of left lower lobe pneumonia with parapneumonic effusion, acute respiratory failure and sepsis. Medical treatment with systemic antibiotics was initiated, but the evolution was unfavorable. Seriated chest X-rays and also high resolution computed tomography with contrast of the lung were performed, revealing the progression to extensive necrotizing pneumonia with multiple cystic lesions causing right mediastinal deflection. The parenteral broad spectrum antibiotic regimen was adjusted, still with unfavorable evolution, requiring surgical treatment (left inferior lobectomy and pleural draining). Postoperatively, recovery was uneventful. The patient was discharged with clinical and laboratory improvement of his condition, a repeated chest X-ray showing good expansion of upper left parenchyma.
Keywords: necrotizing pneumonia, parapneumonic pleural effusion, high resolution computed tomography, pneumococcal infection.

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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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Anca ORZAN, Carmen NOVAC, Mihaela MIHU, Constantin IONESCU-TIRGOVISTE and Mihaela BALGRADEAN

ABSTRACT

Pediatric autoimmune diseases are generally rare and when they occur, they might represent a diagnosis and treatment challenge. Many pediatric systemic autoimmune diseases are different from adults’ diseases, thus turning into a special problem for the physicians and researchers attending the children affected by these diseases. The most frequent autoimmune diseases of children and teenagers are represented by type 1 diabetes mellitus, thyroid disease and coeliac disease. Type 1 diabetes mellitus is the most frequent chronic endocrine-metabolic disease of the child, affecting each race and nationality; its incidence is increasing annually, acquiring a “pandemic” character. Coeliac disease appears more frequently in patients with diabetes mellitus rather than in general population (9% versus 2%) and in 10% of all thyroiditis cases there is an association with type 1 diabetes comparing to 6% on the general population. The family members of children with diabetes are also susceptible of presenting manifestations of certain autoimmune diseases comparing to the general population.
We shall present three cases of patients diagnosed with type 1 diabetes mellitus from an early age, with their disease becoming associated with coeliac disease, thyroiditis and even vitiligo over time. It should be mentioned that in one case, the same autoimmune manifestations were also identified in the father.

Keywords: children, type 1 diabetes, autoimmunity, coeliac disease, thyroiditis

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Felicia GALOS, Catalin BOBOC and Mihaela BALGRADEAN

ABSTRACT

The clinical manifestations of non-erosive gastroesophageal reflux disease (NERD) are multiple and heterogeneous, and differ according to age and individual susceptibility. Weakly acidic reflux and the presence of gas in the refluxate could be relevant in the pathogenesis of symptoms. We present the case of a 3-year and 5-month-old child who came to the hospital with recurrent paroxysmal manifestations without fever assessed. The positive diagnosis was made using pH-metry associated with multichannel intraluminal impedance and glucose respiratory breath test, a new technique that allows positive diagnosis as well as establishes important connections regarding gas reflux and clinical symptomatology described by the patient.
Keywords: Gas reflux, child

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