RESUMO
Although many clinical variants of Staphylococcus aureus infection are well-recognized, atypical presentations may mimic other conditions. We describe two cases of atypical S. aureus infections in pediatric patients: a S. aureus infection presenting with a vesicopustular rash mimicking varicella zoster virus and a case of multifocal panniculitis. Both of these cases were specifically caused by methicillin-resistant S. aureus (MRSA). Additional cases of atypical S. aureus infections and presenting features from the current literature are also discussed.
RESUMO
High-risk infantile hemangiomas may be associated with significant patient comorbidity. The American Academy of Pediatrics published clinical practice guidelines with recommendations to refer high-risk hemangiomas early. The results of this study suggest that these guidelines may have resulted in an earlier referral age of patients with high-risk IH to hemangioma specialists.
Assuntos
Hemangioma Capilar , Hemangioma , Neoplasias Cutâneas , Criança , Hemangioma/diagnóstico , Hemangioma/terapia , Humanos , Lactente , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Resultado do TratamentoRESUMO
BACKGROUND/OBJECTIVES: There is a paucity of validated tools for diagnosing atopic dermatitis (AD) in very young children that do not rely on clinical evaluation. The Childhood Eczema Questionnaire (CEQ)-a diagnostic tool for AD in children younger than 2 years that a caretaker can complete-was recently validated in Sweden. The objective of this study was to validate the tool in a U.S. POPULATION: As a substudy, we added an additional question that was independently assessed. METHODS: Children younger than 2 years old were recruited from a dermatology clinic. Their caretakers completed a questionnaire containing the original tool's three questions as well as a fourth question that increased the time frame measured from 1 week to 6 months. Questionnaires with all "yes" answers were considered positive and were compared with a dermatologist diagnosis of AD. RESULTS: A total of 283 subjects were recruited. The first three questions (the original CEQ) predicted a positive diagnosis of AD with a sensitivity of 0.72 (95% confidence interval [CI] 0.58, 0.82) and a specificity of 0.93 (95% CI 0.87, 0.95). In a separate analysis we included the first two questions and the fourth question and found that the sensitivity increased to 0.82 (95% CI 0.69, 0.90) with a specificity of 0.89 (95% CI 0.83, 0.93). CONCLUSION: This study validates a novel parental questionnaire for the diagnosis of AD in children younger than 2 years in a U.S. clinic population.
Assuntos
Dermatite Atópica/diagnóstico , Inquéritos e Questionários , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pais , Valor Preditivo dos Testes , Encaminhamento e Consulta , Sensibilidade e Especificidade , Estados UnidosRESUMO
Aicardi-Goutières syndrome (AGS) is classically characterized by early-onset encephalopathy. However, in some cases, the presenting symptom of concern may actually be cutaneous rather than neurological, leading to the misdiagnosis of the condition. We report the case of three teenage siblings who presented with a lifetime history of chilblain lesions, only one of whom had notable neurologic deficits. Additional findings included acrocyanosis, Raynaud's phenomenon, low-pitch hoarse voice, headache, and arthritis. They were found to have two pathogenic sequence variants in the SAMHD1 gene: a c.602T>A substitution resulting in p.Ile201Asn protein change, previously reported as a pathogenic mutation, as well as a deletion c.719delT which has not been previously reported but results in a predicted pathogenic frame shift mutation. It is important to consider the diagnosis of AGS in patients and families with chilblain lesions in the presence of unexplained neurologic and rheumatic symptoms. © 2016 Wiley Periodicals, Inc.
Assuntos
Doenças Autoimunes do Sistema Nervoso/diagnóstico , Pérnio/diagnóstico , Malformações do Sistema Nervoso/diagnóstico , Fenótipo , Adolescente , Doenças Autoimunes do Sistema Nervoso/genética , Biópsia , Pérnio/genética , Estudos de Associação Genética , Humanos , Lactente , Masculino , Proteínas Monoméricas de Ligação ao GTP/genética , Mutação , Malformações do Sistema Nervoso/genética , Exame Físico , Proteína 1 com Domínio SAM e Domínio HD , Irmãos , Pele/patologia , Tomografia Computadorizada por Raios XRESUMO
BACKGROUND: In recent years propranolol has become the treatment of choice for infantile hemangiomas (IHs). There is broad variation in the approach to propranolol initiation in clinical practice. This retrospective study explored the effectiveness of routine pre-treatment ECG in screening infants being considered for systemic treatment with propranolol. METHODS: All patients seen in the outpatient pediatric dermatology clinics at Oregon Health and Sciences University (OHSU) and The Mayo Clinic Rochester (MCR), as well as those seen in multidisciplinary vascular anomalies clinics, who had ECGs obtained prior to planned initiation of propranolol for treatment of IH from 2008 to 2013, were identified. A total of 162 patients were included in the study. RESULTS: We found that 43% (69) of routine ECGs were read as abnormal, leading to 28 formal consultation appointments with pediatric cardiologists. After either formal consultation or informal discussion with cardiology, no patients with initially "abnormal" ECGs were ultimately excluded from treatment with propranolol based on routine ECG findings. Additionally no patients in our cohort experienced an adverse effect during treatment that could have been predicted or prevented by ECG prior to initiation of the propranolol. CONCLUSION: Our findings suggest that routine ECG may not be necessary or helpful in the vast majority of patients treated with propranolol for IHs.
Assuntos
Antagonistas Adrenérgicos beta/uso terapêutico , Eletrocardiografia , Hemangioma Capilar/tratamento farmacológico , Propranolol/uso terapêutico , Neoplasias Cutâneas/tratamento farmacológico , Hemangioma , Hemangioma Capilar/diagnóstico por imagem , Humanos , Lactente , Pacientes Ambulatoriais , Estudos Retrospectivos , Neoplasias Cutâneas/diagnóstico por imagem , Resultado do TratamentoRESUMO
Febrile ulceronecrotic Mucha-Habermann disease (FUMHD), a severe form of pityriasis lichenoides et varioliformis acuta (PLEVA), featuring large, ulcerative, necrotic skin plaques, high fever, and other systemic symptoms, is a rare disorder of unknown etiology. No randomized controlled trials have established treatment guidelines and multiple modalities are often employed, making it difficult to assess the efficacy of any single agent. We report two cases of this condition in which treatment with methotrexate plus antibiotic treatment for superinfection led to rapid improvement.
Assuntos
Herpes Simples/diagnóstico , Herpes Simples/tratamento farmacológico , Metotrexato/administração & dosagem , Pitiríase Liquenoide/diagnóstico , Pitiríase Liquenoide/tratamento farmacológico , Superinfecção/prevenção & controle , Biópsia por Agulha , Cefalexina/administração & dosagem , Criança , Relação Dose-Resposta a Droga , Esquema de Medicação , Quimioterapia Combinada , Exantema/diagnóstico , Exantema/etiologia , Febre/diagnóstico , Febre/etiologia , Seguimentos , Hospitalização , Humanos , Imuno-Histoquímica , Masculino , Doenças Raras , Medição de Risco , Estudos de Amostragem , Índice de Gravidade de Doença , Superinfecção/tratamento farmacológico , Resultado do TratamentoRESUMO
Cervicofacial segmental infantile hemangiomas (IH) may result in airway obstruction requiring use of propranolol to induce hemangioma regression and reestablish the airway. We present the first case using intravenous (IV) propranolol for control of airway obstruction and rapid expansion of cervicofacial IH in the setting of necrotizing enterocolitis (NEC) impaired gastrointestinal function. Intravenous dosing of propranolol was tolerated well in a critically ill neonate with multisystem complications of prematurity.