Successful treatment of a child with vascular pythiosis.

BACKGROUND: Human pythiosis is an emerging and life-threatening infectious disease caused by Pythium insidiosum. It occurs primarily in tropical, subtropical and temperate areas of the world, including Thailand. The aim of this report is to present the first pediatric case of typical vascular pythiosis. CASE PRESENTATION: A 10-year-old boy with underlying ß-thalassemia presented with gangrenous ulcers and claudication of the right leg which were unresponsive to antibiotic therapy for 6 weeks. Computerized tomography angiography indicated chronic arterial occlusion involving the right distal external iliac artery and its branches. High-above-knee amputation was urgently done to remove infected arteries and tissues, and to stop disease progression. Antibody to P. insidiosum was detected in a serum sample by the immunoblot and the immunochromatography tests. Fungal culture followed by nucleic sequence analysis was positive for P. insidiosum in the resected iliac arterial tissue. Immunotherapeutic vaccine and antifungal agents were administered. The patient remained well and was discharged after 2 months hospitalization without recurrence of the disease. At the time of this communication he has been symptom-free for 2 years. CONCLUSIONS: The child presented with the classical manifestations of vascular pythiosis as seen in adult cases. However, because pediatricians were unfamiliar with the disease, diagnosis and surgical treatment were delayed. Both early diagnosis and appropriate surgical and medical treatments are crucial for good prognosis.

Hydatid cyst of the abdominal aorta and common iliac arteries complicated by a false aneurysm: a case report.

The rupture of hydatid cysts into the abdominal aorta is an unusual and serious complication of the hydatid disease. The authors describe a case of a 12-year-old girl with hydatid disease presenting as a retroperitoneal mass invading the wall of the abdominal aortic bifurcation and complicated by a false aneurysm. Difficulties of preoperative diagnosis and operative management were discussed, and the literature was reviewed.