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Background: Few pediatric cases with myositis and abscesses of the paraspinal muscles have been previously reported. Case Description: We herein report on a 3-year-old patient who developed an epidural abscess in a paraspinal muscle abscess, after a complication of infectious impetigo due to atopic dermatitis. The child improved through the administration of an antibacterial drug. The median age of seven patients with a history of paraspinal muscle inflammation and muscle abscess was 12 years old (3-15-years-old), few of which had underlying diseases, with methicillin-sensitive Staphylococcus aureus being the main causative agent. Although the prognosis was well in many cases following the administration of antibacterial agents, there were also cases in which extensive lesions were found and neurological sequelae remained. Conclusion: The current case was the youngest case ever reported of a paraspinal muscle abscess. Although pediatric cases are rare, in the episode of a fever of unknown origin and difficulty walking, paraspinal muscle abscesses should be cited as a differential diagnosis and appropriate early diagnostic imaging and treatment should be performed.
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A 3-year-old boy was referred to our hospital for management of Kawasaki disease at 5 days of illness. Echocardiographic examination on admission suggested aneurysmal dilation of the right coronary artery and a possible aorta-left main trunk connection. However, detailed echocardiography at 12 days of illness revealed an abnormal bifurcation of the proximal right coronary artery and no real connection of the aorta-left main trunk, all of which indicated the presence of a single right coronary artery. These diagnoses were confirmed by selective coronary angiography, which was performed later. Considering the difficulties in diagnosing congenital coronary anomalies, which may increase the risk of future fatal events, knowing the disease entity of the congenital coronary arterial anomaly is important for the accurate evaluation of coronary arteries in patients with Kawasaki disease. To the best of our knowledge, this is the first case report of a patient with Kawasaki disease complicated by a single right coronary artery; however, following a search of the literature, we found a brief conference abstract written in Japanese relating to the same clinical condition.
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BACKGROUND: Warfarin administration is essential but requires difficult management and frequent clinic visits in patients with mechanical prosthetic atrioventricular valve replacement (MPAVVR). This study investigated how home prothrombin international ratio (PT-INR) monitoring with CoaguChek® (Roche Diagnostics, Basel, Switzerland) safely reduced clinic visits in children with MPAVVR. We also compared individual correlations between the CoaguChek and laboratory PT-INR. METHODS: This study included four pediatric patients who started frequent warfarin home-monitoring after MPAVVR (three mitral valves and one tricuspid valve). We collected information regarding the number of outpatient clinic visits and measurements of PT-INR before and after starting home CoaguChek monitoring (each one year) from medical records. We also compared individual correlations between laboratory and CoaguChek PT-INR in three patients. RESULTS: No major clinical events were encountered during the study period. The ratio of outpatient clinic visits in the second year to those in the first year was decreased in all patients (0.30-0.66). The ratio of the numbers of home measurements to all PT-INR measurements in the second year ranged from 0.55 to 0.64 indicating that CoaguChek home monitoring approximately halved the number of outpatient clinic visits. CoaguChek measurements tended to be slightly overestimated in two patients but were greatly underestimated in one patient. CONCLUSIONS: CoaguChek home monitoring in children with MPAVVR reduced the number of their clinic visits without compromising the safety of warfarin management. Given considerable individual differences in correlations between CoaguChek and laboratory PT-INR, individual correlation needs to be identified to fairly interpret the CoaguChek PT-INR values.
