Intradural intramedullary spinal cord meningioma in a seven years old female child.

Halima, a 7 years old female child was admitted initially in the Department of Neurosurgery, Bangabandhu Sheikh Mujib Medical University (BSMMU), Shahbagh, Dhaka, Bangladesh with the complaints of burning sensation in the neck for last four month. Initially pain was mild and gradually it became severe and agonizing at night which awakening her from sleep. Following fifteen days of admission, her left hand gradually became weak and numb. Subsequently, all four limbs became involved within one month. Magnetic resonance imaging (MRI) showed expansion of cervical cord with hypo-intense in T1 and inhomogeneous hyper-intense in T2 areas with widening of cervical canal. Post gadolinium diethylene triamine penta-acetic acid dimeglumine (Gd-DTPA) films showed mild heterogeneous contrast enhancement of the cord at the C2-C4 level. The cervical disc showed normal signal intensity on T2WI. During surgical procedure, laminectomy was done at C1-C5 level to release compression and dura matter was opened. Biopsy from involved tissue was taken and sent for histopathological examination and reported as embronal rhabdomyosarcoma. Immunohistochemistry (IHC) of tumor showed negative reaction for desmin, focal positivity for pancytokeratin and positivity for S-100 protein. The tumor was then diagnosed as atypical meningioma,intradural-intramedullary (WHO grade-II). Then, following transfer to the Department of Pediatric Hematology and Oncology, BSMMU, protocol based chemotherapy was started followed by subsequent radiotherapy. The child was gradually improving after decompression of dura matter, commencement of chemotherapy and following external beam radiotherapy. So, an awareness of varied clinical manifestation of atypical meningioma of intrdural-intramedullary spinal cord tumor should be suspected to establish a correct diagnosis when the presenting signs and symptoms are enigmatic, presenting with intractable burning sensation or pain in the neck and investigation should be done accordingly.

Procalcitonin versus C-Reactive Protein as a Biomarker for Prediction of Bacterial Infection in Children with Febrile Neutropenia in Acute Leukemia.

Febrile neutropenia (FN) is a frequently occurring treatment-related complication with significant morbidity and mortality for childhood acute leukemia. Early diagnosis and assessment of severity are essential steps for early comprehensive treatment to reduce FN-related morbidity and mortality. Biomarkers like C-reactive protein (CRP) and procalcitonin (PCT) can be used to assess and predict the bacterial infection in children with febrile neutropenia. The objective of the study was to determine the role of procalcitonin and CRP as a biomarker for prediction of bacterial infection in children with FN in acute leukemia. This prospective observational study was conducted in the Department of Pediatric Hematology and Oncology, Bangabandhu Sheikh Mujib Medical University (BSMMU), Bangladesh from August 2020 to July 2021. Total 58 Children with acute leukemia aged 1 to <18 years with FN were analyzed in this study. A proper history and thorough physical examination were carried out. The blood sample was sent for biomarkers (Procalcitonin and CRP) within 24 hours of the onset of FN and other investigations, such as Complete blood count, Blood C/S, Urine R/E and C/S. Metabolic workup (SGPT, Serum Creatinine, Serum Electrolytes, Serum Ca+) was also done in every patient. Stool R/E & C/S, Chest X-ray, Wound swab for C/S were done when the patient presented with diarrhoea, cough, respiratory distress and focal sepsis respectively. In this study, the mean age of the patients was 6.62±4.07 years (1.10-16.0 years) and 34 patients (58.6%) were male. In 65.5% of patients, localizing signs of infection were not identified. Of the 58 patients, 12 patients (20.7%) showed positive blood culture and 2 patients (3.4%) showed positive urine culture. Klebsiella spp (41.0%) was the most frequent organism isolated followed by Acinetobacter (17.0%), Pseudomonas (17.0%) and E. coli (17.0%). The median PCT levels were significantly higher in patients with bacterial infection than patients without bacteremia (26.10µg/l versus 0.78µg/l, p=0.002) and PCT level >2µg/l was significantly associated with bacteremia. The median CRP levels in the bacteremia and without-bacteremia patients were 137.4mg/L and 54.17mg/L, respectively (p=0.036). In direct comparisons, PCT showed better overall performance than CRP with the AUC being 0.797 (95% CI 0.651-0.943) for PCT and 0.697 (95% CI 0.54-0.855) for CRP in predicting the bacterial infection. PCT and CRP both are useful biomarkers for the prediction of bacteremia, but PCT may be a superior early biomarker as compared to CRP to predict bacterial infection in children with febrile neutropenia in acute leukemia.