Diphyllobothriasis Caused by the Sanada Tapeworm: A Case Report.

The incidence of human diphyllobothriasis is expected to rise amidst the current global popularity of Japanese cuisine, such as sushi, which contains raw fish. We report a case of a 10-year-old boy with a diphyllobothriasis infection acquired via sushi consumption. The patient was otherwise healthy, exhibited no symptoms, and was successfully treated with a single dose of 10 mg/kg praziquantel. In Japan, this parasite is known as "Sanada-mushi" because it resembles a Sanada cord. Prompt recognition of this parasite by evoking the Sanada cord's appearance may facilitate early diagnosis and treatment and increase public awareness to prevent diphyllobothriasis.

Frequent Apnea Attacks in a 1-Month-old Infant With Influenza C Virus Infection.

Influenza C virus infection is a common and mild disease in children. Nevertheless, it remains an under-recognized cause of acute respiratory illnesses. Herein, we report the case of a 54-day-old infant who developed an influenza C virus infection and frequent apnea attacks, which could be a risk factor for sudden death and has never been reported earlier.

Case report: Thyroid storm in a three-year-old girl presenting with febrile status epilepticus and hypoglycemia.

Thyroid storm, though extremely rare in toddlers, requires prompt diagnosis and treatment because it can be fatal if left untreated. However, thyroid storm is not often considered in the differential diagnosis of a febrile convulsion due to its rarity in children. Herein, we report the case of a 3-year-old girl with thyroid storm who presented with febrile status epilepticus. Although the seizure was stopped by diazepam administration, her tachycardia and widened pulse pressure persisted, and severe hypoglycemia was observed. Based on the findings of thyromegaly, a history of excessive sweating and hyperactivity, and a family history of Graves' disease, she was eventually diagnosed with a thyroid storm. The patient was successfully treated with thiamazole, landiolol, hydrocortisone, and potassium iodide. Propranolol, a non-selective ß-blocker, has been used to manage tachycardia during thyroid storm. However, a cardio-selective ß1-blockers, landiolol hydrochloride, was used in our case to avoid worsening hypoglycemia. Febrile status epilepticus is one of the most common medical emergencies in childhood; it is necessary to rule out treatable underlying critical diseases such as septic meningitis and encephalitis. Thyroid storm should be considered in children presenting with prolonged febrile convulsion accompanied by findings that are not usually observed with febrile convulsions.

Non-thyroidal Illness Syndrome in an Infant With Acute Anorexia and Psychological Stress.

Non-thyroidal illness syndrome (NTIS), a remarkable ensemble of changes in serum thyroid hormone concentration during acute illness, was first reported in the 1970s. While NTIS is not a form of hypothyroidism, it is characterized by a decrease in serum triiodothyronine (T3) or thyroxine (T4) or both with normal or decreased thyroid-stimulating hormone (TSH). Notably, it typically resolves without thyroid hormone replacement therapy. We report a case of paralytic ileus caused by NTIS in an infant with psychological stress. This case illustrates the development of NTIS during psychological stress, which can lead to severe symptoms such as those seen in pathological hypothyroidism.

Incarcerated Umbilical Hernia Treated With Adhesive Strapping in a Three-Month-Old Infant.

An umbilical hernia (UH) is a common condition in early childhood; it is defined as the protrusion of abdominal viscera through a defect in the umbilical ring. Since most UHs close spontaneously, almost no active treatment has been performed. Adhesive strapping (AS) for early UH closure is an easy-to-perform and relatively safe treatment. However, it can present rare but serious complications. Herein, we report a case of a three-month-old infant with incarcerated UH during AS therapy. AS treatment for UH, which has been reported mainly in Japan, has shown excellent results in observational studies and could be widely applied globally. However, our case demonstrated the presence of a noteworthy complication; incarcerated UH, in addition to skin complications, such as cellulitis and skin ulcer-related perforation, was associated with AS. To minimize the occurrence of these complications associated with AS treatment for UH, it is crucial to adequately explain and guide the family members regarding the proper management of AS and seeking medical care promptly when abnormalities occur during AS.

Unusual Acute Pediatric Pyelonephritis Presenting With Cluster Convulsions by Possible Central Nervous System Lesion: A Case Report.

Acute pyelonephritis is the leading cause of bacterial infection among children. It can be difficult to diagnose early in the disease course owing to non-specific symptoms and physical findings. Recently, some cases of pediatric acute pyelonephritis with mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) have been reported. We describe a case of a six-year-old boy who presented with a high fever and four episodes of cluster convulsions. Despite the absence of leukocyturia and hypo-inflammatory response in the blood, he was diagnosed with acute pyelonephritis by contrast-enhanced computed tomography seven days after onset. The convulsions were not simple febrile convulsions and suggested central nervous system (CNS) lesions, as the patient was older than the usual cut-off age of five years for febrile seizures. This case highlights an unusual presentation and clinical course of a case of pediatric acute pyelonephritis characterized by cluster convulsions and a poor inflammatory response. Furthermore, we strongly consider that the cause of the cluster convulsions may be related to MERS spectrum disorder and emphasize that pyelonephritis can be accompanied by CNS disturbances.

No child should suffer from vitamin K deficiency-induced bleeding disorders.

We encountered an 11-day-old male neonate with vitamin K deficiency-induced intracranial hemorrhage, despite receiving oral vitamin K2 (menaquinone-4) prophylaxis according to Japanese guidelines. This case suggests that the current vitamin K deficiency-bleeding prophylaxis programs cannot prevent bleeding completely. Better prophylaxis programs using both intramuscular and oral administration should be considered.

Kawasaki disease resembling acute colitis.

This report presents a case of atypical Kawasaki disease (KD) in a 4-year-old boy developing with severe colitis accompanied by frequent diarrhoea and hypokalemic dehydration. Abdominal ultrasonography showed findings of left colon mucosal thickening and prominent dilatation of the colon. Antibiotic treatment was not effective. Some symptoms of KD appeared with progression of the illness. Intravenous immunoglobulin (IVIG) was administered based on a diagnosis of incomplete KD on the ninth day of the illness. The patient became afebrile soon after IVIG therapy. Diarrhoea and other symptoms dramatically subsided. The patient has recovered during the 3-month follow-up and repeated echocardiograms were normal.

Sensitivity to gemcitabine and its metabolizing enzymes in neuroblastoma.

PURPOSE: We examined the activity of gemcitabine against neuroblastoma in vitro and in vivo. In addition, we investigated the cellular mechanisms of high sensitivity to the agent in neuroblastoma cells. EXPERIMENTAL DESIGN: We examined 11 neuroblastoma cell lines for sensitivity to gemcitabine and other chemotherapeutic agents used clinically for neuroblastoma. The in vivo sensitivity of neuroblastoma to gemcitabine was determined in xenograft models. Furthermore, the major metabolic enzymes of gemcitabine were assessed and compared in leukemia and carcinoma cells. Apoptosis and mitochondrial membrane potentials were also evaluated. RESULTS: The IC50s for gemcitabine in 11 neuroblastoma lines ranged between 3 nmol/L and 4 micromol/L. The high activity of gemcitabine against neuroblastoma was confirmed in animal models. Interestingly, enzymes in neuroblastoma cells involved in the metabolism of deoxycytidine analogue have unique characteristics among solid tumors. The median of deoxycytidine kinase activity in neuroblastoma lines was similar to that in leukemia lines, which have low IC50s for cytarabine. Cytidine deaminase (CDA) activity in neuroblastoma was hardly detectable and significantly lower than that in carcinoma. The defect of CDA activity was associated with negative expression of mRNA. Furthermore, gemcitabine-induced apoptosis was observed irrespective of the caspase-8 status of neuroblastoma cells, which indicates that apoptosis depends on the mitochondrial pathway. CONCLUSIONS: Neuroblastoma is highly sensitive to gemcitabine. Although the cellular mechanism involved in sensitivity to gemcitabine is multifactorial, low CDA activity may contribute high sensitivity in neuroblastoma cells. These results suggest that clinical application of gemcitabine to the treatment of neuroblastoma is warranted.

Impact of cytidine deaminase activity on intrinsic resistance to cytarabine in carcinoma cells.

Cytarabine (araC) is a highly active antimetabolite against hematological malignancy while the agent shows limited activity against carcinomas. In this study, we focused on cellular transport and catalysis of the nucleoside in order to elucidate the mechanism of intrinsic resistance to araC in carcinomas. Activities of two metabolizing enzymes for araC, deoxycytidine kinase (DCK) and cytidine deaminase (CDA), and cellular transport of the agent were examined in 9 carcinoma cell lines. These variables in carcinoma lines were compared with those in 14 araC-sensitive leukemia lines and one leukemia line with acquired resistance. The mean IC50 in 9 carcinoma lines was 3 x 10(3)-fold higher than that in 14 leukemia lines (4.6 x 10(3) vs. 1.3 microM, p<0.01). A cell line with acquired resistance (U937R), which was established from U937 monocytoid leukemia cells, showed more than 10(3)-fold higher IC50 than the parent cells (1.6 x 10(3) vs. 1.3 microM). The resistance in carcinomas was associated with higher CDA activity and lower influx when compared to araC sensitive leukemias. Especially, these two types of malignant cell lines were clearly distinguished by CDA activity. The acquired resistance in U937R cells was followed by increase in cytidine deaminase (CDA) activity, decrease in DCK activity and decrease in influx of the drug. In conclusion, carcinomas are intrinsically resistant to cytarabine through high CDA activity and low cellular transport, but not low DCK activity. This finding suggests that treatment of carcinoma with deoxycytidine analogues should conquer the high CDA activity.

A case of juvenile myelomonocytic leukemia with concomitant cytomegalovirus infection.

Infantile cytomegalovirus (CMV)-associated disease and juvenile myelomonocytic leukemia (JMML) frequently present with similar clinical features, and thus the differential diagnosis is often difficult. An early and definite diagnosis of these disorders is required because their therapeutic approaches are very different. The authors describe a 2-month-old Japanese girl with JMML and CMV infection. The CMV antigen was detected by immunologic staining of leukocytes using the peroxidase-labeled monoclonal antibody HRP-C7. To assess clonality, the X-chromosome inactivation pattern was evaluated using polymerase chain reaction analysis of the human androgen receptor gene with or without predigestion of chromosomal DNA with HhaI or HpaII. The patient showed evidence of monoclonal origin of mononuclear cells at diagnosis. Although CMV infection mimicking JMML has previously been reported in two patients, to the authors' knowledge this is the first report describing a firm and definitive diagnosis of JMML based on the study of X-chromosome inactivation patterns.

BK virus-associated fatal renal failure following late-onset hemorrhagic cystitis in an unrelated bone marrow transplantation.

The human polyomavirus BK (BKV)-associated hemorrhagic cystitis (HC) has been a frequent and, seldom life-threatening complication after bone marrow transplantation (BMT). The authors report a male with melodysplastic syndrome, who developed BKV-associated late-onset HC 12 days after HLA-matched unrelated BMT. His urine contained epithelial cells with intranuclear inclusion bodies suggestive of BKV infection and was positive for BKV in polymerase chain reaction. He did not respond to any treatment for HC. In addition, he developed BKV-associated acute renal failure on day 26, followed by hepatic veno-occlusive disease on day 42. This is the first case in which BKV may be associated with fatal progressive renal failure.