Caroli's syndrome with autosomal recessive polycystic kidney disease.

Caroli's syndrome (CS) is a rare congenital disorder characterized by multiple segmental cystic or saccular dilatations of the intrahepatic bile ducts and congenital hepatic fibrosis. We report a 9-year-old boy who was diagnosed with CS and autosomal recessive poly-cystic kidney disease. On screening, his 5-month-old asymptomatic sister had multiple dilated biliary radicals with multiple bilateral renal cystic lesions. Both the patient and the affected sibling have been advised regular follow-up for monitoring the progression of the disease. In conclusion, patients with CS should be screened for renal cystic lesions and vice versa even if they are asymptomatic. Also, as the disease is inherited in an autosomal recessive manner, it is important to screen family members for early diagnosis and management.

Acute renal failure associated with malaria in children.

Acute renal failure is one of the serious complications of malaria with untoward consequences including increased risk of mortality. This study was conducted to evaluate the incidence, clinical features, course, outcome, and predictors of mortality of acute renal failure (ARF) in children with malaria in the pediatric general wards and intensive care unit of our medical center from 1 January 2009 to 31 December 2009. Data of all children from 1 month to 12 years of age with confirmed malaria either on peripheral smear and/or OptiMal test were reviewed. Those suffering from ARF were selected for further study. Twelve (eight Plasmodium falciparum; three Plasmodium vivax, and one mixed infection) out of 227 (5%) cases of confirmed malaria had ARF. In addition to ARF, most of the patients had at least one other manifestation of severe malaria. Nine (75%) patients recovered completely, while 3 (25%) died. Presence of associated cerebral malaria, hyperbilirubinemia, and disseminated intravascular coagulopathy (DIC) was a poor prognostic factor and predictor of mortality. In conclusion, ARF can complicate both P. falciparum and P. vivax malaria. Malarial ARF as an isolated complication has a good prognosis. The presence of multiorgan involvement and delayed diagnosis increases morbidity and mortality.

Sodium artesunate-induced diuresis in a patient with malaria.

Sodium artesunate is used in the treatment of malaria. We report a case of sodium artesunate induced diuresis and natriuresis in a patient with malaria. Following artesunate administration there was polyuria accompanied by natriuresis that was reversed after discontinuation of artesunate treatment. The diuretic effect of artesunate can modify the course of renal failure in severe malaria. Prescribers should be aware of this effect of artesunate, so that it can be used judiciously and to the advantage of patients with severe malaria.

Paradoxical response to anti-tubercular treatment.

We report a 5-year-old boy who developed optic neuritis as a paradoxical reaction to anti-tuberculous therapy. Steroids were re-started in the patient with gradual recovery of his vision. The case emphasizes the importance of recognizing paradoxical reactions in patients on anti-tuberculous therapy. Prompt recognition and treatment of such reactions will reduce the associated morbidity.

Thalamic pain syndrome due to cytomegalovirus vasculitis in an HIV-positive child.

Dejerine-Roussy syndrome, also known as the thalamic pain syndrome is a condition in which the body becomes hypersensitive to pain as a result of damage to the thalamus, a part of the brain that affects sensation. Association of this syndrome with HIV is rare with few case reports described in adults. We report a 10 year old male child who was HIV positive and had developed this syndrome due to cytomegalovirus vasculitis.

Hypokalemic paralysis following severe vomiting in a child with intestinal obstruction due to round worms.

Ascariasis is one of the most common helminthic infestations in humans. Massive infestation can give rise to serious complications such as intestinal obstruction. We present a 4-year-old boy, who presented with acute flaccid quadriparesis due to the hypokalemic alkalosis induced by severe vomiting. Severe vomiting was due to intestinal obstruction caused by round worms.