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Introduction: Aneurysmal bone cyst (ABC) of cervical spine is rare in the pediatric age groups. It brings along a gamut of problems in management such as growth disturbances, instability, deformities, and neurological deficiencies. We report a case that was successfully managed by intralesional injection, making it safe and reproducible. Case Report: A 12-year-old girl presented with pain and swelling around the nape of neck that increased in size over 1 year. Imaging and biopsy were suggestive of ABC. She was managed with selective embolization and percutaneous injection of methylprednisolone and calcitonin. Injections were given twice over 2 months period. At 1½ year follow-up, the patient was asymptomatic and swelling had shrunk in size and lesions ossified. Conclusion: ABC'S are rare lesions that can create therapeutic dilemma in the pediatric population. Intralesional injection of calcitonin and methylprednisolone can prove to be a safer and efficacious treatment modality.
RESUMO
A wide spectrum of cutaneous manifestations are reported in multisystem inflammatory syndrome in children (MIS-C). However, gangrenous changes are less frequently reported. A 3-year old boy, with a known case of unoperated tetralogy of Fallot, presented with a short history of fever, rash, and melena. The rash was black and diffuse, with a rapid progression. The patient was stable hemodynamically at admission, with pallor, grade II clubbing, edema, and oral ulcers. Inflammatory markers were raised. He developed gangrenous changes over the ears and acral areas. He had very high levels of antibodies to severe acute respiratory syndrome coronavirus2 (SARS-CoV-2) infection and was diagnosed as having MIS-C. Skin biopsy revealed near total epidermal necrosis with dermal vascular thrombi and negative immunofluorescence. Skin biopsy was positive for IgG antibodies to SARS-CoV-2. He was treated with antibiotics, immunomodulation with steroids, intravenous immunoglobulin, and plasmapheresis. He had features of both micro- and macroangiopathy. Gradually the child improved, with residual deformity.