PurposeOesophageal squamous papilloma (OSP) is a rare epithelial lesion with an unclear aetiology, found incidentally in upper gastrointestinal endoscopy (UGE). We evaluate the epidemiology, general features and endoscopic and histological characteristics of OSP in children in a single centre.MethodsWe conducted a retrospective search of 3568 medical records of children under 18 years old who underwent UGE between 2004 and 2022, at Hospital Metropolitano de Quito, Ecuador. We described the general features of 15 patients diagnosed with OSP. Histopathology reports were analysed, including a chromogenic in situ hybridisation (CISH) for human papillomavirus (HPV) 6/11.ResultsOSP was diagnosed in 15 patients between 10 and 16 years of age, with an estimated prevalence of 0.4%. The gender ratio male to female was 1:1.1. Most patients (n=14) underwent UGE due to abdominal pain. Lesions were found predominantly in the upper and lower part of the oesophagus; 12 patients had isolated lesions, and none of the lesions tested positive for HPV on CISH 6/11 analysis. Additionally,Helicobacter pyloriand eosinophilic oesophagitis (EoE) were diagnosed in one patient each.ConclusionOur study describes the clinical features of paediatric OSP in a single centre. The prevalence was similar to that in the adult population but higher than in other paediatric populations, and none of our patients had HPV.
Food protein-induced enterocolitis syndrome (FPIES) is a gastrointestinal, non-IgE mediated, and food hypersensitivity syndrome, and particularly occurs in infants during the introduction of new foods. There is no specific diagnostic test for FPIES, and therefore, diagnosis relies on medical records, symptoms presented, oral food challenges, and symptomatic relief after dietary avoidance. 1 Contrastingly, necrotizing enterocolitis (NEC) is a lifethreatening emergency of the gastrointestinal tract that almost exclusively affects newborns, with 70% of these cases occurring in preterm infants (<36 weeks of gestation). 2 This condition warrants treatment with broad-spectrum antibiotics, bowel rests, inotropes, and fluid support. 3 The diagnosis of FPIES can be challenging, as its clinical manifestations may mimic other diseases such as NEC, leading to misdiagnosis. Symptoms that arise in both conditions include vomiting, abdominal distention, diarrhea, bloody stools, feeding difficulties, lethargy, apnea, and shock. Additionally, in both conditions, diagnostic tests, such as abdominal radiography, may show intestinal dilatation, pneumatosis intestinalis (PI), and portal venous gas. 4 We present a case of FPIES in a 1-month-old, exclusively breastfed male, initially diagnosed with NEC, showing persistent PI on radiography and metabolic acidosis in the venous blood gas test. Our objective was to highlight the diagnostic difficulties associated with FPIES in exclusively breastfed infants. | CLINICAL CASEThe patient was a 1-month-old male, born at 38 + 6 weeks of gestation, with a history of transient tachypnea (requiring oxygen for less than 24 h) and a patent foramen ovale. He had no personal or family history of allergic conditions
RESUMENIntroducción: la hepatitis de células gigantes con anemia hemolítica autoinmune (HCG-AHAI) es una condición rara y grave que se presenta por lo regular en el primer año de vida. No hay una prueba diagnóstica específica. Se caracteriza histológicamente por una transformación de los hepatocitos en células gigantes. Presentación del caso: paciente masculino que a la edad de 45 días de vida inicia con ictericia, palidez y hepatomegalia. Se evidenció leucocitosis, anemia normocítica con Coombs directo positivo, así como de elevación de bilirrubinas, lactato deshidrogenasa y transaminasas. Serología negativa para sífilis, toxoplasma, rubéola, citomegalovirus y herpes simple. El diagnóstico se estableció por hallazgos histopatológicos en biopsia hepática, más anemia hemolítica. El paciente fue tratado con esteroides y azatioprina. Hasta la edad de ocho años, se ha mantenido con evolución satisfactoria sin recaídas, y con mejoría del patrón histopatológico. Conclusiones: la HCG-AHAI es una enfermedad grave que debe sospecharse en lactantes con anemia hemolítica, más datos de hepatitis aguda después de descartar otras causas de hepatitis.
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