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Treatment was initiated with oral penicillin for ten days, with resolution of the symptoms. |
An eight-year-old boy attended the Ophthalmology Department complaining of vesicular lesions caused by pruriginous vesicles improvement on the right but not topical herpes zoster, diagnosed with herpes zoster |
Because of this, the antiviral agent is substantiated due to its oral presentation, without showing improvement in six days. Then, a corticosteroid withdrawal is indicated for culture and a skin lesion is indicated prior to topical treatment with beta-blockers. |
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Three weeks later, the patient underwent a review, which showed a slight decrease in pruritus, with stagnation of previous lesions, maintaining a large scaling and erythematous keratosis with poorly defined base. |
Culture is positive for Candida krusei, so previous therapies are withdrawn, recommending oral griseofulvin in two daily doses with disappearance of fat meals and suspending an improvement of cutaneous signs, producing 14 days. |
A seven-year-old girl who came to the emergency room in spring due to an episode of complex generalized crisis with disconnection of the middle and fall of the lip floor while recovering spontaneously, sialorrhea and movements. |
The previous days the child had presented with myalgias, headache and fever of up to 39 °C, but she had already suffered from arthritis for 24 hours. |
The patient was a girl with no relevant physiological history: pregnancy, delivery and perinatal period without interest. She also had no relevant pathological history and, as a family history, only maternal lithium treatment for bipolar disorder of years of evolution. |
The patient, upon arrival to the emergency department, had a post-critical condition with a Glasgow score of 10, but the rest of the examination, both neurological and systems, was normal. |
Blood tests revealed the following: |
• Biochemistry: |
— Glutamic-oxalacetic transaminase (GOT): 93 IU/l. |
— Glutamic-pyruvic transaminase (GPT): 44 IU/l. |
— C-reactive protein (CRP): 2 mg/l. |
• Blood count: |
— Activated leukocytes: 6000 (N: 30% L: 66% M: 4%). |
— Platelets 125 000. |
— Normal red series. |
The patient was admitted to the emergency department with seizure disorder. |
Two hours after admission, the patient developed a new seizure and monitoring with intravenous midazolam 0.15 mg/kg, but suffered respiratory arrest requiring T-piece ventilation, so the admission was decided. |
Upon arrival to the intensive care unit, the patient presented post-critical condition, with Glasgow score of 7 and the rest of normal parameters except for an axillary temperature of 38 °C. Neurological examination revealed marked hyperreflexia in the lower limbs. |
Urgent cranial computed tomography (CT), lumbar puncture, toxic urine and blood tests (due to maternal history) were performed, with normal results. |
Urgent electroencephalogram (EEG) was performed and the activity compatible with meningoencephalitis was reported as global slowing. |
Cerebrospinal fluid (CSF) serology was performed for enterovirus and herpes virus, both of which were negative. |
Serology is also obtained for multiple agents such as toxoplasma, rubella, lees, herpes simplex 1 and 2, varicella-zoster virus, Mycoplasma, adenovirus, parotiditis, Cox parvovirus, |
In the following hours after admission, the patient presents agitation episodes with drowsiness and again presents two generalized convulsive episodes, so maintenance levetiracetam was initiated despite 40 mg/kg/day of prior prophylactic treatment with 20 mg/kg/day. |
Emergency brain magnetic resonance imaging (MRI) was performed with normal results and no bleeding or hyperdensity lesions were observed. |
fever of the previous days and poor recovery of neurological symptoms, it was decided to determine influenza A antigens in the nasal exudate, resulting positive, so treatment with ostamidine was initiated. |
Progressively, the patient improved, but suffered a new seizure episode and it was decided to extend serology to cytomegalovirus (CMV), Ebstein's virus remains normal (EBV), herpes and influenza negative. |
Oligoclonal bands that are negative are requested in CSF and autoimmunity study with anti-DNA, anti-Ro, anti-La, anti-histoplasma, anti-Sm, anti-neutrophils. |
Valproic acid is associated with doses of 40 mg/kg/day, with complete remission of seizures. |
The patient had five seizures and at discharge an EEG improvement was observed, although not completely normal. |
Treatment was continued with valproic 40 mg/kg/day and levetiracepam 60 mg/kg/day. |
Currently, the patient follows controls in Neurology outpatient clinics, without anticonvulsant medication and remains asymptomatic, with normal EEG findings in the last visit. |
A three-year-old and a half-year-old male with severe neurological damage secondary to a perinatal ischemic stroke. |
She comes to consultation with her mother, who tells us an unusual crying a few weeks ago and the suspicion that the child has hand pain. |
He also comments that the child has been treated with oral steroids for a few weeks, since during the follow-up of his neurological damage, when he consulted for musculoskeletal system symptoms he suffered from idiopathic chronic arthritis with normal radiographs of hands. |
He is the only child of non-consanguineous parents. |
The father tends to have a bone problem in his wrists since childhood; he remembers having suffered wrist pains when he was a child and refers to the fact that he does not have the bones of his normal wrists and that he does not keeps his profession. |
The physical examination of the child is conditioned by its neurological damage (emitting cries, without language of another type and listening and attending when speaking, smiling with the caresses); it is not capable of ambulation without speech. |
Somatometry includes a skull perimeter of 46 cm (< P3), a length of 104 cm (P25-50) and a weight of 16.5 kg (P50). |
Blood pressure values were normal (111/66 mmHg). |
No characteristic features are observed. |
Attention is paid to the child's repeated attempt to bite his right wrist. |
There are no inflammatory signs and it is expressed with gemides upon repeated mobilization of this right wrist. |
No other manifestations were observed. |
The father is 180 cm tall, but his arm span is reduced to 164 cm. His hand is 18.7 cm long (corresponding to 8.3 cm for height) with a third finger (normal). |
The paternal X-ray showed bilateral absence of congenital malformations. |
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X-rays of the child showed lesions consistent with osteolysis and unilateral tarsal scaling lesions. |
1. |
We requested consultation of the genetics service where we studied and confirmed the diagnosis of autosomal dominant multicentric osteolysis without nephropathy. |
Previously healthy child. |
He was operated on for left cryptorchidism as the only antecedents; he is vaccinated correctly for his age. |
Five years old presented for the first time bilateral parotid inflammation (with erythema, swelling and pain), fever that was managed on an outpatient basis with amoxicillin-clavulanic acid and oral amoxicillin. |
She had a second episode, also managed on an outpatient basis. |
The third episode required hospital admission due to poor clinical outcome and affectation of the general condition after starting treatment with oral amoxicillin-clavulanic acid. |
The physical examination revealed a bilateral laterocervical tumor (disorderly right) that effaced the mandibular angle, without signs of fluctuation or secretion or inflammatory signs of Stenon's duct. |
Blood tests showed significant leukocytosis (24 100/mm3), neutrophilia (78.7%), C-reactive protein (CRP) 4.11 mg/dl and elevated α51 U/hasta. |
During admission, an ultrasound showed an increase in parotid size, increased density, heterogeneous and with hypoechoic foci. |
The patient was treated with amoxicillin-clavulanic acid for two days intravenously, completing eight more days orally, analgesia and anaphylaxis, with good subsequent evolution. |
The Pediatric Infectious Diseases Department has followed up the patient since the study was completed. |
An immunity study has been performed, which has been normal, rheumatoid tests, negative and serological study, negative, except serology vaccine antiparotitis, which was positive. |
Currently, she has not presented new episodes for more than a year. |
Four-year-old patient, born in Mali and adopted at six months of age, with no significant pathological history and correct immunizations. |
It was characterized by the appearance of papular skin lesions and crusted plaques with a tendency to converge on the anterior aspect of the right thigh. |
Initially topical fusidic acid was prescribed, without clinical improvement and with the appearance of similar lesions in the trunk, the root of the extremities and face. |
There was no palmoplantar or mucosal involvement. |
The lesions were not pruritic. |
1. |
Upon reinterruption and exploration of the patient again, an isolated lesion on the dorsum of the right foot, of oval morphology, hyperpigmented with desquamative collar and perimarginal plaque, which had preceded the rest. |
The final diagnosis was Gibert pityriasis rosea in a black patient, symptomatic treatment was initiated with good evolution. |
A one-and-a-half-month-old girl presented with fever (38 °C) of 48 hours onset and irritation, associated nasal mucus. On physical examination she presented erythematous rash of small elements and the rest of normal examination. |
In an initial laboratory test: leukocytes 6310/μl (segmented 67%, fallen 6%, lymphocytes 19%, monocytes 8%), hemoglobin (Hb) 10.9 g/dl, hematocrit (Hto) 29.6%, reactive protein |
Lumbar puncture was performed: glucose 51.3 mg/dl, protein 133.9 mg/dl (hemorrhagic liquid). |
Given the suspicion of severe bacterial infection, she was admitted for intravenous antibiotic treatment with cefoxime and ampicillin (200 mg/kg/day), adding in the following 24 hours herpes simplex virus to cover (60 mg/kg/day). |
Febrile at 48 hours. |
On the fourth day she presented irritation, bad color and general condition, with persistence of evanescent exanthema and respiratory distress. Control laboratory tests were performed with finding: leukocytes 2670/μl 11% atypical segments Hb 31%, lymphocytes |
capillary gas: pH 7.32, PCO2 43.3 and HCO3 21.8 mmol/l. |
Chest X-ray : Bilateral alveolointerstitial infiltrates Radiography, more striking on the left side, suggestive of acute pulmonary edema. |
Located as pancytic, samples are extracted for parvovirus and enterovirus, as well as for influenza A. High flow therapy is initiated and the patient is transferred to a tertiary care pediatric hospital. |
1. |
Immunoglobulin M (IgM) for parvovirus B19 are positive and IgG negative, making diagnosis of parvovirus B19 infection, respiratory failure and pancit associated antibodies. |
The patient showed progressive improvement on the fifth day of admission and was discharged on the twelfth day without further complications. |
The child's brother later presents erythema infectiosum. |
We report the case of a three-month-old infant with a one-month history of refusal to take, nausea, regurgitation and vomiting. |
For this reason she was referred from Primary Care to the Emergency Department. |
He was a term birth weight appropriate for gestational age, with a normal course pregnancy in which polyhydramnios was not observed. |
The neonatal period was uneventful, presenting adequate psychomotor and height development up to two months of age, when the clinical presentation was described. |
Upon arrival at the Emergency Room, the patient was impressed by general condition, dry, ojerous mucous membranes, capillary refill greater than 2 seconds and cutaneous dryness, with rest of the normal physical examination. |
Vital signs were: temperature, 36.6 °C; heart rate, 137 bpm; blood pressure, 88/55 mmHg (p75); O2 saturation, 100%; respiratory rate, 52 rpm; height, 90 cm. |
It was expanded with saline and blood tests were performed, with normal and biochemical blood count, highlighting: Na 151 mEq/l; K 2.2 mEq/L; Cl 130 gap/l and Hall in normal calcium and albumin 13 mg/dl. |
A urine dipstick with pH 7, density 1015 and negative rest was performed. |
The patient required intravenous serum therapy with maximum potassium mEq/l and bicarbonate (3kg/day), and was discharged within one week, maintaining oral treatment with sodium bicarbonate and potassium citrate. |
Renal ultrasound showed bilateral papillary hyperechogenicity, compatible with the onset of nephrocalcinosis. |
Assessment was performed, bone series and auditory potentials were normal. |
During the follow-up period up to nine months of age, the patient is asymptomatic, with maturational development (p25 of weight and p50 of height), so weight changes have been made according to dosage adjustments. |
The laboratory tests performed six months after discharge are shown in Table 2. |
Follow-up ultrasound performed six months after discharge showed persistent findings consistent with nephrocalcinosis. |
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