Posterior reversible encephalopathy in a child with Langerhans cell histiocytosis following allogeneic PBSCT treatment with cyclosporine.

Posterior reversible encephalopathy syndrome (PRES) is associated with a specific disorder of cerebrovascular autoregulation of multiple etiologies. This syndrome had been subsequently described in numerous medical conditions, including hypertensive encephalopathy, pre-eclampsia and the use with immunosuppressive drugs. Here, we report a child suffering from Langerhans cell histocytosis developing into PRES following immunosuppressive therapy. Symptoms and neuroimaging abnormalities were complete resolution subsequent to the withdrawal of cyclosporine. Although PRES is rarely seen among children, it should always be considered in the differential diagnosis of acute neurological illness, especially undergoing immunosuppressive therapy.

Intrapleural streptokinase for the treatment of childhood empyema.

BACKGROUND: Pleuritis with empyema is a serious complication of bacterial pneumonia, which often causes substantial morbidity and mortality among pediatric patients. Currently percutaneous catheter drainage is the mainstay therapy for loculated empyema. Intrapleural instillation of streptokinase, urokinase, and recombinant tissue plasminogen activator has been reported to facilitate the drainage of viscous fluid and fibrinous debris or multiple loculations from the pleural space of such patients. METHODS: In this study, we compared with the treatments of pleural empyema by instillation of streptokinase through the chest tube and using the conventional chest tube drainage alone. RESULTS: We collected 21 cases from 1999 through 2005. The results of the study showed that streptokinase (SK) group patients revealed a larger volume of drainage in the beginning days of the instillation and required fewer days of drainage than tube drainage (T) group patients [8 (4.5 - 10) days vs. 16 (5.8 - 20.3) days, p = 0.02]; that the SK group patients required average 2.6 instillations. The SK patients had a shorter febrile course than the T group [12.5 (9.5 - 15.5) days vs. 16 (9.5 - 22.5) days, p = 0.14]. None of the SK patients needed additional video-assisted thoracoscopic surgery (VATS) whereas 5 patients in the T group did. The length of hospitalization in the SK group was 21.5 days and the T group patients was 24 days. CONCLUSIONS: Intrapleural instillation of streptokinase seldom caused clinical adverse effect and appears to be a safe adjunctive therapy to facilitate the drainage of empyema in pediatric patients. Further studies with better research design to compare the fibrinolytic agent instillation and the VATS as the first step treatment of childhood empyema are needed.

Cat-scratch disease in children at a medical center.

BACKGROUND: Cat-scratch disease (CSD) is a well-recognized, benign, self-limited regional lymphadenopathy occurring in immunocompetent patients. Several retrospective studies have demonstrated that CSD occurs at all ages, however, the disease appears to be more common in children. We conducted a retrospective case study of CSD in children presenting at our hospital, and reviewed the relevant literature. METHODS: The medical records for eight children (age range 4-13 years) diagnosed with cat-scratch disease at the Tri-service General Hospital in Taipei from September 1, 1986 to September 1, 2002 were retrospectively reviewed. Clinical manifestations, diagnostic methods, and treatment types were assessed. RESULTS: The male gender predominated (75%); the median age was 8.6 years. The latency period ranged from 7 days to 1 month, with a median diagnostic interval of 8.5 days. There were no deaths. All patients had lymphadenopathy, and the axillary node was the most prevalent site (62.5%). The most common locations for the scratch or inoculation lesions were the hands and/or fingers (62.5%). Three patients were diagnosed from clinical symptoms and history (37.5%), three from serological study (37.5 %), and two using biopsy or aspiration (25%). All patients were given antibiotic treatment. The most commonly used antibiotic was gentamicin (75%), with the average duration of treatment 8.7 days. The average hospital stay was 8 days, with the lymph-node size reduced relative to pretreatment baseline in all except one case. CONCLUSION: In our experience, the long-term prognosis for children with typical CSD is favorable, and gentamicin may be a good antibiotic option.