Cholestatic jaundice in the neonatal period becomes difficult to diagnose because of complex and diverse etiology. The Index case was severe IUGR (intrauterine growth restriction), with a maternal history of infection and leaking per vaginum. The baby cried immediately at birth but was very low birth weight and short for gestation. Soon after birth, the baby developed respiratory distress and had poor activity. The baby was diagnosed of having hyaline membrane disease and early onset of neonatal sepsis and was managed appropriately. Later the baby developed conjugate neonatal hyperbilirubinemia and sepsis was taken as a cause of it and obstructive causes were ruled out. But the baby was not responding well to the treatment and the liver function test remained deranged, so is presented as a diagnostic challenge. The ultrasonography of the abdomen was normal. TORCH (Toxoplasma gondii, Other agents, Rubella, Cytomegalovirus) profile of the baby was sent which turned out to be positive for Cytomegalovirus (CMV). The viral load was high. Hence the baby was treated with Ganciclovir and the baby responded remarkably with the liver enzymes getting reverted to normal and viral load subsequently reduced to zilch. The infant started thriving well and no apparent associated neurological manifestations of the disease were seen in the baby. Currently, the baby is on regular follow-up. The difficulties experienced in the identification of CMV leading to delay in the management of the newborn as well as the positive outcome with Ganciclovir therapy are highlighted in this article. Our goal of reporting this case is to raise pediatricians’ and other stakeholders’ awareness of congenital CMV infection to ensure early detection and appropriate treatment of affected babies, with the ultimate goal of improving their prognosis and preventing the associated audiological and cognitive sequelae. Keywords: Cholestasis; Cytomegalovirus; Gancyclovir.
There is always need for the earliest diagnosis of enteric fever to start the appropriate treatment for this life threatening illness. The diagnosis becomes difficult because of inherent limitation due to the long standing vague complaints. Some findings like acalculus cholecystitis, hepato-splenomegaly, enlarged mesenteric lymph nodes (MLN) and free fluid can easily be picked up by ultrasonography (USG). USG is easily available, without any ionizing radiation, non-invasive and economical. Hemoculture and Widal tests are time consuming and the cost is quite high. The study was conducted with 100 paediatric patients aged 1-year to 15-year. All were having enteric fever based on typhi dot-IgM presented to the paediatric department of the hospital. USG was conducted for the evaluation of the various relevant findings. Blood samples for CBC, LFT and blood culture were taken on the same day as that of USG evaluation. USG evaluation of confirmed enteric fever cases revealed that 25% had gall bladder findings, 23% had hepato-splenomegaly, 11% had hepatomegaly, 1% had enlarged mesenteric lymph nodes (MLN) and 3% had thickened caecum wall and ileocaecal junction. USG can diagnose many findings which are related to enteric fever and are helpful in starting the early management. Hemoculture and other investigations may delay the treatment which can lead to various complications.
COVID-19 infection has been associated with several neurologic manifestations including anosmia, acute ischemic stroke, Guillain-Barré syndrome, encephalopathy and cranial nerve involvement. Though multiple cases of unilateral facial nerve palsy have been reported but bilateral facial palsy is very rare. Our case was 12 years old female patient who presented with difficulty in closing mouth, drooling of saliva and change in voice. On examination, there was loss of bilateral nasolabial folds, nasal twang of speech and incomplete eye closure bilaterally. Laboratory reports suggested raised CRP and amylase along with positive Immunoglobulin IgG covid-19 antibodies. Magnetic Resonance Imaging of brain and neck showed no abnormality. The child was managed conservatively with supportive care, subsequent to which she gradually improved over next 4-6 weeks. To the best of our knowledge, this is the first pediatric case where SARS-COV2 infection was found to be associated with bilateral facial nerve palsy as a post covid complication. Therefore, bilateral facial palsy should be considered as one of the associations of COVID especially in the present era. A detailed history and examination should be done as it often gets missed due to bilateral involvement. All differential diagnosis should be ruled out by relevant laboratory & radiological tests. Most children are likely to recover well with supportive treatment.
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