Sir, A normal 2-yr-old girl presented with loose motions and vomiting followed by drowsiness. History revealed that the patient had developed these symptoms within 30 min of consumption of a yellow funnel shaped flower. Examination revealed an irregularly irregular heart rate with ST segment elevation on electrocardiogram with intermittent bradycardia. Blood pressure was 60/42 mm Hg in the right arm in supine position and the respiratory rate was 45/min with acidotic breathing. On central nervous system examination, the child was drowsy but arousable. Pupils were bilaterally equal and reacting to light. There was no cranial nerve palsy or focal neurological deficit. Gastric lavage yielded a yellow colored fluid. Activated charcoal was administered after the lavage in the casualty, which was approximately after 45 min of consumption of the flower. The sensorium rapidly deteriorated and patient became comatose. Intravenous fluids and antibiotic coverage was given. Patient had decreased perfusion and hypotension, for which a dopamine drip was started. Bradycardia was treated with intravenous atropine. Elective endotracheal intubation was undertaken and patient was mechanically ventilated. Serum potassium was 7 mmol/dl and an arterial blood gas revealed compensated metabolic acidosis which were treated as per standard guidelines. Later, the child developed an episode of generalized tonic-clonic convulsion for which she required injection midazolam and injection phenytoin intravenously. As signs of II degree heart block were seen on ECG, temporary pacing was planned, but patient developed asystole and did not respond to resuscitative measures. The flower ingested was confirmed by the father as yellow oleander from the photograph in the textbook of toxicology.
Sydenham Chorea (St. Vitus dance) occurs in about 10-15% of children with acute rheumatic fever. Herein, we present the case of a 5-year-old male child with hemichorea and arthralgia. The child also presented with mild mitral regurgitation and mild aortic regurgitation. Appropriate management is essential to prevent mortality, morbidity, and psychosocial disability in such cases. We would also like to shed light on the challenges faced in the management of chorea in young children with key emphasis on the anticipation of adverse reactions to commonly used medications.
Acute rheumatic fever (ARF) is still one of the most common cause of acquired heart disease in school age group children. Though there has been a decline in the past few decades, resurgence of ARF cases have been noted in developing countries. We are hereby reporting a 7 year old male child who presented to us with ARF without any cardiac complications and absence of any serological evidence of recent streptococcal infection. The child however had a history of throat infection prior to joint involvement with this case we want to emphasize the importance of history taking and the fact that even if there is no serological evidence of streptococcal infection, the case has to be treated as ARF with the fulfilment of major and minor criteria to prevent mortality due to cardiac complications.
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