Acute neurological symptoms in multisystem inflammatory syndrome in children: A case series.

Introduction: Severe acute respiratory syndrome coronavirus-2 infection mostly involves pediatrics lesser than adults; however, the multisystem inflammatory syndrome in children is shown to be the following condition in children infected with SARS-CoV-2, even asymptomatic ones. To date, there is few evidence of the association of multisystem inflammatory syndrome in children with acute neurological symptoms. Case presentations: This case series was recorded demographic, clinical, laboratory, radiographic and EEG data of patients with the multisystem inflammatory syndrome in children who diagnosed simultaneously with acute neurological symptoms. Children with the multisystem inflammatory syndrome in children and evidence of central nervous system involvements participated in the study. Data are reported as median (interquartile ranges) for quantitative data without normal distributions. The present study was conducted at the children's referral hospital of Isfahan province, Iran between March 1, 2020, and December 28, 2021. Simultaneous diagnosis of multisystem inflammatory syndrome in children and acute neurological symptoms was made in 12 children. The median age of patients was 4.5 years (10-144 months). The most common symptoms were seizures (58%). Cerebrospinal fluid analysis showed that only one patient had pleocytosis. In addition, one patient had a low glucose level. Finally, 11 patients were discharged in good condition and one patient died after full recovery from acute neurological symptoms due to her underlying disease. Conclusion: According to our series and other studies, children with MIS-C may present signs and symptoms of acute neurological symptoms. Although its pathophysiology is unclear, studies showed that immunomodulatory agents, i.e., intravenous immunoglobulins and corticosteroids, provide a relatively good prognosis.

Coexistence of Type B Insulin Resistance and Chronic Inflammatory Demyelinating Polyneuropathy (CIDP) in Type 2 Diabetes Mellitus: Various Manifestations With the Same Pathophysiologic Base?

Chronic inflammatory demyelinating polyneuropathy (CIDP) is a rarely reported disease. The association between diabetes mellitus (DM) and CIDP has been a matter of controversy. Here we presented a 59-year old male patient with uncontrolled type 2 DM presented with simultaneous type B insulin resistance (TBIRS) and CIDP. Both blood glucose and neurological manifestations responded well to corticosteroid therapies. Although the pathogenesis of CIDP remains to be elucidated, the role of antibodies in the pathogenesis of TBIRS and CIDP might be a promising platform for further studies to provide additional insights into the origin of these 2 rare complications.

Congenital renal arteriovenous fistula presenting with gross hematuria and its management.

Renal arteriovenous fistula (AVF), an abnormal connection between artery and vein, results from development failure or following vascular injury. AVFs may cause various complications, i.e., secondary hypertension and hematuria. To manage AVF, it is recommended to bypass it from blood circulation surgically or by percutaneous embolization. The present study describes a woman with AVF, who primarily was managed percutaneously and then surgically.

Longitudinally extensive transverse myelitis as a sign of multisystem inflammatory syndrome following COVID-19 infection: A pediatric case report.

COVID-19 infection can cause inflammatory reactions that could involve several organs. In the pediatric population, Multi-System Inflammatory Syndrome in Children (MIS-C) has been reported as one of the consequences of COVID-19. We report a unique pediatric COVID-19 patient with MIS-C, associated with paralysis of the extremities. MRI showed abnormal signal in the cervical spinal cord compatible with transverse myelitis. Methylprednisolone and IVIG were administered, without significant symptom improvement. As a next step, Infliximab was tried for her, and she responded remarkably well to this treatment. Infliximab may be considered as a treatment option in COVID-19 patients with transverse myelitis.

Gastric phytobezoars as a very unusual cause of gastric outlet obstruction.

Bezoars are collections of indigestible foreign material found in the gastrointestinal tract. Phytobezoars are the most common among the types of bezoars. Treatment of phytobezoars is categorized into four types: chemical dissolution, endoscopic removal, adjuvant prokinetics, and surgery. Complications from phytobezoars can include gastric outlet obstruction (GOO), ileus, ulcerations, gastrointestinal bleeding, and perforation. Herein, we present an 86-year-old woman with refractory postprandial vomiting. Then, exploratory laparotomy was performed and the diagnosis was gastric phytobezoar. Phytobezoars-induced GOO is rare and its diagnosis is still a challenge.

Case Report: Acute Intracardiac Thrombosis in Children With Coronavirus Disease 2019 (COVID-19).

We herein describe a case series of children with SARS-CoV-2 infection (COVID-19) complicated with acute intracardiac thrombosis. The diagnosis of COVID-19 was confirmed through the reverse transcription-polymerase chain reaction (RT-PCR). Transthoracic echocardiography of patients revealed large intracardiac mobile masses resected successfully via cardiac surgery. The underlying mechanisms of this thrombus in the COVID-19 infection may be attributed to the hypercoagulation and inflammatory state of the disease incurred by the SARS-CoV-2 virus.

Nonspecific orbital inflammation and thyroid eye disease, a rare comorbidity: report of two cases and review of literature.

BACKGROUND: To present the very rare comorbidity of developing non-specific orbital inflammation (NSOI) in two patients with histories of definite thyroid eye disease (TED). CASE PRESENTATION: Both patients complained of new-onset progressive proptosis although their thyroid disease was controlled and computed tomography scan revealed an intraorbital inflammatory mass. The pathological assessment indicated that both patients had developed fibrosing NSOI. Therefore, intravenous corticosteroids were administered. The mass regressed and the amount of proptosis was decreased in both patients. CONCLUSIONS: We reviewed all related cases in the literature and extracted their clinical and radiological characteristics for this paper. Ophthalmologists should consider TED and NSOI in patients with a new-onset complaint of proptosis. Despite rare comorbidity of TED and NSOI, it should be considered especially in patients with refractory proptosis, and lead to its further evaluation and prompt management.