Transient unilateral oculomotor palsy and severe headache in childhood Kawasaki disease.

Transient affliction of the cranial nerves may at times be either the presenting feature or complication of otherwise uncomplicated Kawasaki disease (KD) in infants and children. The present report describes a 6 year 9 month old boy with classical KD who developed right-sided oculomotor nerve palsy (manifested by ipsilateral ptosis and medial rectus palsy) resulting in symptoms like severe nausea, intense frontal headache and double vision. The palsy resolved within 5 days of intravenous immunoglobulin therapy, with no residual ophthalmological abnormality at 6 weeks. Besides increased intracranial pressure, which commonly occurs during the course of KD in children, secondary to aseptic meningitis, intense headache in such children may have cranial nerve paresis as accentuating factors.

Atypical Kawasaki disease with remarkable paucity of signs and symptoms.

We report on a 7-month-old infant with Kawasaki disease (KD) whose only manifestations were high-grade fever of 7 days duration, "non-toxic look" and "extreme irritability", thereby not meeting the criteria for the classical or the atypical form of the disease. The diagnosis was confirmed by the demonstration of a solitary aneurysm in the proximal left anterior descending coronary artery. The present case raises the concern that the presently laid guidelines for the diagnosis of atypical KD may not be adequate.

Childhood cerebral vivax malaria with pancytopenia.

We report on a 7-year-old girl with cerebral vivax malaria complicated by pancytopenia. The diagnosis of malaria was done by demonstration of trophozoites of Plasmodium vivax in the peripheral blood smear and confirmed by both a species-specific antigen detection technique and a sensitive polymerase chain reaction method. There was depression of all 3 blood cell lines. No overt manifestations attributed directly to pancytopenia were noted. The patient responded promptly to artesunate and pancytopenia was managed conservatively. To our knowledge, this is the first report of pancytopenia complicating childhood cerebral vivax malaria in the English literature.

Hypomelanosis of ito-whorled hyperpigmentation combination: a mirror image presentation.

We hereby report a 2-year-old boy who presented with a peculiar combination of hyperpigmented and hypopigmented skin lesions along the lines of Blaschko, sharply demarcated at the midline, both on the anterior and posterior trunk. Although combinations of hyperpigmented and hypopigmented skin lesions distributed along the lines of Blaschko have been described, the combination of skin lesion comprised hypomelanosis of Ito and whorled hypermelanosis distributed in the extremely unusual manner described in this patient has not been reported previously.

Splenic abscess as a complication of enteric fever.

A rare and unrecognized complication of enteric fever is splenic abscess. We report two cases of childhood enteric fever complicated by splenic abscess (one solitary and the other multiple).

Difficulties in the diagnosis of Kawasaki disease.

This study aims to highlight the difficulties faced in the clinical diagnosis of Kawasaki Disease (KD) presenting beyond the first week. This is a retrospective study of 25 cases of which only 36% met the criteria for classical and 8% was incomplete KD. Majority (56%) did not meet the criteria for classical KD; at the same time they were not incomplete / atypical cases. Difficulties arise in diagnosis of the cases presenting in the second week, as by that time many of the classical findings disappear or probably have not been present at all. In this scenario high index of suspicion for KD in a child presenting with fever, looking not that sick (Non toxic look) with bulbar conjunctivitis and oral mucositis helped us to reach the diagnosis. We incidentally observed Hyperemia of the Upper Eyelids in 32% of our cases, which might assist in the diagnosis.