Extensive Idiopathic Calcinosis in a Child - A Diagnostic and Therapeutic Imbroglio.

Idiopathic calcinosis is a disorder characterized by diffuse calcium deposits at various sites of the body. Etiopathogenic associations are described with inherited disorders, connective tissue disorders, infections, tumors, trauma, and endocrine disturbances. No diagnostic tests or standard therapeutic guidelines are established for this entity. There is paucity of literature on idiopathic calcinosis. We describe a girl child with extensive calcinosis in the skin and around muscle bundles without any clinical and laboratory evidence for etiological associations. Aggressive treatment modalities resulted a notable improvement in lesions in index child. Growing evidence will help to establish the ground for understanding and developing standard therapy.

DRESS syndrome due to first-line antitubercular therapy - A diagnostic imbroglio!

Drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome after the use of first-line antitubercular drugs (ATDs) is rare and literature regarding DRESS syndrome due to ATDs is scarce in children. We report a young boy with tuberculosis who developed DRESS syndrome after exposure to isoniazid. A 9-year-old boy, diagnosed clinically as pulmonary tuberculosis, presented with fever, fast breathing, maculopapular rash, and one episode of gross hematuria. He had been on 4-drug ATD therapy (isoniazid, rifampicin, ethambutol, and pyrazinamide) for the past 4 weeks. In view of multiorgan involvement and absence of a microbiological diagnosis of tuberculosis, vasculitis was considered and he was treated with steroids. As the child recovered, both corticosteroids and ATD therapy were stopped. At 6 months of follow-up, he was presented with pneumonia. Microbiological diagnosis of tuberculosis was made and 4-drug ATD therapy was reinitiated. After 15 days, he again developed a high-grade fever and rash. On evaluation, isoniazid-induced DRESS syndrome was diagnosed. Subsequently, he received a modified regimen of ethambutol, pyrazinamide, levofloxacin, and linezolid. DRESS syndrome did not recur on these ATDs and the child became asymptomatic. Linezolid was stopped after 3 months of therapy and ethambutol, pyrazinamide, and levofloxacin are being continued. Currently, he has completed 15 months of modified ATD therapy. As a high index of suspicion is required for early diagnosis and management that are crucial to reducing morbidity and mortality, DRESS syndrome should be among the differentials in children with unexplained febrile illnesses.

Extensive Mongolian Spots in a Hypotonic Infant with GM1 Gangliosidosis.

Mongolian spots (MS), also known as dermal melanocytosis, are the most frequently seen birthmarks and generally present as large, blue or blue-black macules or patches, mostly limited to the lumbosacral region. They are considered as a benign manifestation; however, extensive MS can be a manifestation of certain underlying inborn errors of metabolism including GM1 gangliosidosis.