Chemotherapy induced juvenile dermatomyositis: a novel presentation- a case report.

BACKGROUND: Idiopathic connective tissue disease juvenile dermatomyositis (JDM) is characterised by inflammatory myositis and distinctive skin abnormalities. Only a few cases of Dermatomyositis (DM) owing to chemotherapy used to treat cancer have been reported, despite the fact that the link between DM and cancer in adults is widely known. We describe the case of a female, age 14, who experienced DM as a side effect of chemotherapy following enucleation for retinoblastoma. We also discussed our patient's likely pathophysiology of JDM after treatment. CASE PRESENTATION: A 14-year-old female came to our facility complaining of trouble walking and bluish-black discoloration on her neck, elbows, forehead, and knees that had been present for eight months. The patient had undergone enucleation of the left eye due to retinoblastoma, followed by 40 cycles of radiation therapy and 13 cycles of chemotherapy with Cyclophosphamide, Etoposide, Carboplatin, Vincristine, and Dactinomycin. Her serum LDH and CPK levels were high, and she tested positive for ANA. The muscle biopsy was consistent with the changes of DM. When electromyography was performed, it revealed tiny, fibrillating, polyphasic motor unit potentials and sharp, positive waves that were suggestive with DM. A diagnosis of JDM was made after taking into account the symptoms, biochemical data, muscle biopsy, and electromyography results. The patient's symptoms started to get better once methotrexate and oral corticosteroids were started. CONCLUSION: This case report emphasises the value of ongoing observation after cancer chemotherapy because specific cutaneous and muscle symptoms may lead paediatricians to consider the possibility of chemotherapy-induced JDM, which is uncommon in young patients.

Mucormycosis in a case of multisystem inflammatory syndrome in children: "double trouble" (case report).

Multisystem inflammatory syndrome (MIS-C) in the pediatric age group is a clinical syndrome in children and adolescents which is recognized in association with a high local prevalence of Corona Virus Disease-2019 (COVID-19). Mucormycosis is a severe form of fungal infection and often affects immunocompromised patients. It is associated with high morbidity and mortality and is characterized by extensive angioinvasion and necrosis of the affected tissue. Currently, this dreaded mucormycosis is rising among COVID-19 pediatric patients during their treatment period or after their discharge from the hospital. It is also called COVID-19- associated mucormycosis (CAM) or black fungus. In the head and neck area, rhino-orbital-cerebral mucormycosis is the most common presentation and a fatal clinical entity associated with COVID-19 infections. There are several cases of mucormycosis reported in cases with COVID-19 infection, but there is limited data available for the development of mucormycosis in MIS-C. Here, we report a case of a nine years old girl who developed mucormycosis while suffering from MIS-C. The patient was brought to our institute with complaints of fever for 3 days associated with redness of the eyes and swelling behind both ears and bilateral conjunctival congestion. Subsequently, she started showing signs of end organ damage in form oliguria and deranged liver function. Her COVID-19 antibody titer was positive and hence was diagnosed as MIS-C. She had prolonged hospitalization during which she started developing black discoloration over the nose. The histopathology report of the lesion was suggestive of mucormycosis. Eventually, the patient died due to multiple organ dysfunction. There is not only an association of mucormycosis in COVID-19- positive patients, but it shows some association with its complications like MIS-C. There is very limited data available for the association of mucormycosis and MIS-C but early diagnosis and intervention play a vital role in the outcome of the patient.