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Introduction Pericardial effusions are rare yet potentially fatal conditions in children. Azacitidine is a DNA-hypomethylating agent used in the treatment of myelodysplastic syndrome. Although seldomly described in adults, no cases of azacitidine-induced pericardial effusion have been reported in children. Case report A 7-year-old boy with myelodysplastic syndrome presented with a large pericardial effusion with risk for cardiac tamponade after his first azacitidine cycle. Management & outcome The patient was admitted to a pediatric ICU, antibiotic and steroid therapy were initiated. Pericardiocentesis was done due to hemodynamic instability. Serum and pericardial fluid complementary evaluation excluded infectious and malignant causes. The pericardial effusion did not reappear and additional pleural and ascitic slight effusions responded well to diuretics. Follow-up azacitidine cycles were administered by tapering daily dosages and using adjunctive steroid therapy, with no additional adverse events. Discussion We report the first pediatric case of large pericardial effusion secondary to azacitidine therapy in a child with MDS. This adverse reaction has not been described in pediatric patients, in which this therapeutic option has been increasingly used. We seek to raise awareness on the potential life-threatening cardiotoxicity of azacitidine in pediatric patients.

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Images of the diagnosis and correction of a pseudo-aneurysm at the right ventricular outflow tract, one of the rarest complications of Tetralogy of Fallot surgical correction.

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The authors report the case of an 18‐year‐old woman with Turner Syndrome and aortic coarctation, who developed aortic dissection after percutaneous stenting. Surgical treatment was necessary as the lesion progressed. This case highlights both the importance of awareness as well as multidisciplinary management of this potential complication.

Passive transfer of antibodies secondary to intravenous immunoglobulin infusion is a rare but important side effect that can lead to the wrong diagnosis and therapeutic decisions. It has never been reported in a newborn. A male newborn, vaccinated against hepatitis B and diagnosed with dilated cardiomyopathy, presented positive hepatitis B core antibodies at 12 days of life. Exclusion of hepatitis B infection was mandatory as it would be a contraindication to heart transplant. Passive transfer of antibodies was confirmed at 44 days of age, after seroreversion of hepatitis B core antibodies. Passive transfer of antibodies after intravenous immunoglobulin infusion can lead to a misleading diagnosis if not recognized. In our patient it could have been especially harmful had it prevented heart transplant. Screening for hepatitis B should be performed at least 1 month after intravenous immunoglobulin infusion. RESUMOA transferência passiva de anticorpos secundária à infusão de imunoglobulina endovenosa é um efeito secundário raro, mas importante, que pode levar a um diagnóstico e decisões terapêuticas erradas. Nunca foi descrito num recém-nascido. Um recém-nascido do sexo masculino, vacinado contra a hepatite B e diagnosticado com miocardiopatia dilatada, apresentou anticorpos anti-core do vírus da hepatite B aos 12 dias de vida. A exclusão da infecção por hepatite B foi obrigatória, pois seria uma contra-indicação ao transplante cardíaco. A transferência de anticorpos através de imunoglobulina endovenosa foi confirmada aos 44 dias de idade, após sero-reversão dos níveis de anticorpos anti-core do vírus da hepatite B. A transferência passiva de anticorpos após a infusão de imunoglobulina endovenosa pode levar a um diagnóstico errado se não for reconhecida. Neste doente poderia ter sido especialmente prejudicial caso tivesse impedido o transplante de coração. O rastreio para hepatite B deve ser realizado pelo menos um mês após a infusão. ABSTRACTHypertrophic and keloid scars represent hyperproliferative disorders that can have a significant impact on patients' lives. The authors present the case of a 53-years-old male with a sternal keloid after excision of a sebaceous cyst and multiple sessions of steroid infiltration, with worsening of the lesion. The patient underwent complete excision of the scar and reconstruction with an anterolateral thigh flap -ALT. The postoperative period was uneventful, with no signs of relapse. Keloid scar treatment in sternal area implies a reconstruction with no tension, in order to avoid relapse. Treatment of this type of scars is complex and a challenge to the plastic surgeon.