The authors presented the cases of two children with inflammatory myofibroblastic (IMF) tumor and reviewed the literature to facilitate the preoperative recognition, delineate the clinical features, and describe the natural history of this entity. The first child had IMF tumor arising from the mesentery of the small intestine. He presented with an abdominal mass associated with severe inflammatory response manifested by fever, impaired growth, thrombocytosis, and microcytic, hypochromic anemia. After surgical resection, his fever resolved and his growth rate and the laboratory abnormalities normalized. Five months after initial diagnosis, the fever, anemia, and thrombocytosis recurred along with two tumors arising from the omentum and the abdominal soft tissue. After the second surgery, he remains free of recurrent disease for 30 months. The second child presented with a lung mass that was radiologically indistinguishable from pulmonary sequestration. After surgical resection, she remains free of recurrent disease for 18 months. IMF tumor should be considered in any solid tumor that occurs in association with a chronic inflammatory response. IMF tumor should also be considered in the differential diagnosis of pulmonary sequestration.

Five commercially available activated partial thromboplastin time (APTT) test systems were compared with the kaolin partial thromboplastin time (KPTT) method to determine sensitivity in detecting minor coagulation defects. All reagent systems detected severe factor VIII-, IX-, and XI-deficient hemophilia. Homozygous states of factor XII deficiency, Fletcher factor deficiency, and high-molecular-weight kininogen deficiency (Fitzgerald trait) also showed abnormally long APTTs by all systems. Of 19 samples from patients with deficiencies of factors XII, VIII, IX, XI, and II ranging from 2.5 to 52%, eight had deficiencies that were not detected by reagent A (ellagic acid); two, by reagent B (ellagic acid); two, by reagent C (kaolin); one, by reagent D (silica); one, by the KPTT method. All deficiencies were detected by reagent E (celite). Heparin effect on plasma was less well detected by reagent A (ellagic acid) than with the other test systems. APTT test systems can vary greatly in their abilities to detect minor coagulation abnormalities.

This is the first report of infection caused by "Mycobacterium lacticola," a rapidly growing, scotochromogenic mycobacterium that was isolated from the blood of an immunosuppressed child. The organism was identified by sequence analysis of >1,400 bp of the 16S rRNA gene. The clinical relevance of this isolate, coupled with its unique 16S rRNA gene sequence, should prompt further investigation to establish this organism as a valid mycobacterial species. CASE REPORTA 4-year-old girl developed fever to 38.2°C 3 months following autologous stem cell transplantation required after myeloablative chemotherapy to treat stage III neuroblastoma. Her physical examination did not reveal a source for her fever, including a normal-appearing Hickman catheter exit site. Counts were as follows (per liter unless other units are given): hemoglobin, 9.7 g/dl; white blood cells, 3.4 ϫ 10 9 ; neutrophils, 2.3 ϫ 10 9 ; lymphocytes, 0.5 ϫ 10 9 ; monocytes, 0.4 ϫ 10 9 ; eosinophils, 0.1 ϫ 10 9 ; platelets, 40 ϫ 10 9 . Serum electrolytes, creatinine, hepatic enzymes, and albumin were within normal limits. A bone marrow examination demonstrated hypocellularity consistent with a myelodysplastic syndrome or delayed engraftment. Blood from the Hickman catheter and a peripheral site was collected in BACTEC aerobic pediatric resin bottles (Becton Dickinson, Sparks, Md.). Blood cultures were incubated in the BACTEC 9240 blood culture instrument with a 5-day incubation protocol. Within 48 h, the culture from the Hickman catheter was positive with a branching gram-positive beaded rod that was subsequently identified as an acid-fast bacillus by carbol fuchsin staining. The peripheral blood culture was positive at 96 h (4 days) with the same organism. Repeat cultures, obtained 2 days after the initial blood cultures, were also positive within 48 h from the catheter and 120 h (5 days) from the peripheral sample. The time to positivity of the peripheral and catheter blood cultures suggested a catheter infection. Treatment with azithromycin and rifampin was initiated although the patient remained well with no additional fever after day 2. The catheter was removed, and antibiotic treatment was continued for 5 days. The patient remained afebrile and in her usual state of health. Subsequent blood and bone marrow cultures were sterile.Initial subcultures from the blood bottles to chocolate, Middlebrook 7H11, and Löwenstein-Jensen agars failed to reveal growth after 2 weeks of incubation at 37°C. Subcultures to these media incubated at 30°C demonstrated yellow-orangepigmented colonies of acid-fast bacilli after 4 days. Once the organism was recovered on solid media, additional serial subcultures to Löwenstein-Jensen and 7H11 agars demonstrated almost equal amounts of growth at 30 and 37°C within 5 days.PCR amplification and restriction fragment length polymorphism (RFLP) analysis of the hsp65 gene were undertaken to identify the organism by the method of Telenti et al. (14). The resulting RFLP pattern did not match any pattern in our database or the publis...

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