Paraneoplastic myopathy as a very rare manifestation of acute lymphoblastic leukemia.

We present a 9-year-old girl who developed acute muscular weakness of proximal muscles of the upper and lower limbs. Investigations revealed a common acute lymphoblastic leukemia. The neuromuscular symptoms are classified as a paraneoplastic neurological syndrome (PNS). Under chemotherapy according to ALL-BFM-2000 protocol symptoms resolved within 4 weeks. This case presents a rare manifestation of acute lymphoblastic manifestation.

[Neonatal seizures caused by lamotrigin withdrawal?]. / Neugeborenen-Krämpfe durch Lamotrigin-Entzug?

We report about a 3-day-old full-term newborn who suffered from series of tonic-clonic and myoclonic seizures. His mother was treated with lamotrigin for epilepsy. It is worthy of note that the drug level of the neonate had already decreas-ed to 37% of the basic level of his mother. At the same time, there was a catabolic metabolic situation and a mild hyponatriaemia. We believe that the neonatal seizures were caused by lamotrigin withdrawal.

Subacute sclerosing panencephalitis in two brothers.

We report the occurrence of subacute sclerosing panencephalitis (SSPE) in two brothers two years after measles infection. The diagnosis was confirmed by compatible data from medical history, occurrence of autochthonic measles virus (MV) IgG production in the central nervous system (CNS), and pathognomonic EEG changes. Pathogenetically, SSPE is caused by a genome mutation of intracellularly persisting MV, causing viral nucleocapsides to accumulate in the brain cells. A specific predisposing immune defect is not known. The occurrence of two cases in one family is suggestive of a genetic predisposing factor.

[Congenital syphilis after reactivation of "healed" maternal primary infection]. / Lues connata nach Reaktivierung einer "ausgeheilten" mütterlichen Primärinfektion.

UNLABELLED: The congenital syphilis is an infectious fetopathy which is able to affect the whole organism. In most cases symptoms are not obvious before week fourth to twelve of life. The infection of the mother is the precondition for the child's disease. The placental transfer takes place after the fifth to sixth month of gestation. We report about an eight week old baby with congenital syphilis. The positive maternal laboratory findings in the 4th month of pregnancy have been interpreted as a completely cured earlier infection causing a sero scar. The diagnosis became evident by serological tests detecting reactivation of maternal infection in late pregnancy and the clinical signs of acute infection of the child. CONCLUSION: There is a high risk of reactivation of maternal syphilis in the third trimenon even if the mother does not show any symptoms. In this case further serological tests in the prenatal care and careful examination of the newborn must be initiated.

[Factitious skin lesions as an expression of a family crisis]. / Artifizielle Ekchymosen als Ausdruck einer familiären Krise.

The factitious disorder is a deliberately induced, hidden self-mutilation based on a psychic conflict. We present a previously healthy nine-year old girl with initially obscure symmetric skin lesions. Family history, psychological exploration, special tests like pictural expression and scenial exhibition revealed the child's fear of a divorce of her parents and her own identity problem. These examinations aroused the suspicion that the girl could only express her conflict of ambivalence by self-injury behavior in the meaning of artificial disease. Guided by this impression, an intensive conversation with both parents was undertaken, focussing the familiar crisis. Afterwards, the skin lesions disappeared the girl admitted the self-mutilation. A family therapy was initiated.