Hypertensive Crisis in a Pediatric Patient Experiencing Clonidine Withdrawal.

Background: Clonidine, a central alpha-adrenoreceptor agonist, was initially developed as an antihypertensive. Though no longer commonly used for its original indication due to rebound hypertension after discontinuation, it is currently widely prescribed as a treatment for many pediatric indications including sleep disorders, behavioral concerns, and attention deficit hyperactivity disorder. Case Report. We describe a girl who developed prolonged symptoms of clonidine withdrawal, including hypertension and elevated serum metanephrines. Discussion. Clonidine withdrawal in pediatric patient can present with hypertensive urgency and other signs of sympathetic stimulation. Withdrawal can also lead to dramatic elevation in serum metanephrines. Treatment with a clonidine taper will reduce development of withdrawal symptoms. Conclusion: Given the rise in clonidine use in pediatric patients, clinicians should be aware of the risk of clonidine withdrawal and how to recognize and avoid its development.

U.S. Refugee Resettlement Is in Ruins-It Is Our Duty to Rebuild It.

Beginning in 2017, policy changes impacting the U.S. Refugee Admissions Program (USRAP) led to dramatic cuts in U.S. refugee resettlement. These changes have impeded relief of humanitarian crises, compromising the safety of tens of thousands of refugees eligible for resettlement and delaying family reunification. Rebuilding USRAP will require significant funding, support, and time. Such rebuilding is a necessary step in addressing the global refugee crisis and a potential life-saving intervention for many refugees, who suffer a range of threats and maladies. Many have chronic untreated medical issues and untold psychological trauma-physical and emotional wounds from years of persecution. They need-and deserve-our help.

Escherichia Coli bacteremia and rapidly progressive cellulitis in a child with newly diagnosed nephrotic syndrome.

Nephrotic syndrome (NS) in children is associated with spontaneous bacterial infections, including peritonitis as well as cellulitis secondary to chronic third-spacing of intracellular fluid. Typical pathogens that cause cellulitis in these patients are gram-positive bacteria whereas gram-negative organisms are uncommon. We report a case of Escherichia coli bacteremia with associated rapidly progressive cellulitis in an 11-year-old child with newly diagnosed NS, who had only recently started steroid therapy. Our case highlights the multifactorial effects of NS on the immune system that result in a predisposition towards infection. It also underscores the importance of a broad approach to neuro-atypical children with common clinical complaints.

Bacteremia in a Newborn with Hypocalcemic Seizures and Vitamin D Deficiency.

Infants with neonatal hypocalcemia often present with seizures, and neonatal hypocalcemia can be due to parathyroid (PTH) insufficiency or resistance. Causes of hypocalcemia with PTH elevation include increased phosphate load, vitamin D deficiency (VDD) or defects in metabolism, renal dysfunction, hypomagnesemia, genetic mutations resulting in end-organ resistance to PTH, or critical illness. Hypocalcemia has also been shown to be associated with Gram-negative bacteremia and sepsis in adults. We present the case of a full-term, formula-fed newborn presenting with late-onset hypocalcemic seizures and VDD in the setting of Klebsiella pneumoniae bacteremia. This case highlights that newborns presenting with hypocalcemic seizures should undergo a workup for sepsis.

First reported case of vertebral osteomyelitis due to Erysipelothrix rhusiopathiae.

We describe a case of acute vertebral osteomyelitis with associated prevertebral abscess due to Erysipelothrix rhusiopathiae in an immunocompetent adult with recent known traumatic inoculation from the barb of a fish.