People in different age groups are susceptible to SARS-CoV-2 infection as a newly emerging virus. However, the clinical course, symptoms and disease outcome vary from case to case. Although COVID-19 is usually milder in children than adults, some studies reported nonspecific symptoms. Here, we report eight pediatric cases of COVID-19 admitted in the Taleghani Children Hospital in Gorgan city, north of Iran, with complicated symptoms. The current case series poses several challenges to the pediatricians regarding the pediatric cases of COVID-19. As most literature relating to adults are not always transferable to children, clinicians should be warned about such presentations among children with COVID-19.
Introduction: Rapid-onset obesity concurrently with hypoventilation, hypothalamic, autonomic dysregulation (ROHHAD) is an uncommon disease that presents with multiorgan disorders during early childhood, with fewer than 100 cases reported around the world. We aim to present a case of ROHHAD syndrome admitting with rare neurologic symptoms. We also present our treatment regimen. Case Presentation: An 8-year-old boy was admitted to our department with ataxia and gait disturbance that led us to the final diagnosis after a thorough investigation. He had multiple admissions and was treated for other diagnoses. His first symptoms started from age 5 with obstructive apnea. He underwent an adenectomy surgery at that time, but the symptoms continued. A year after the surgery, he was admitted again due to his somnolence but was diagnosed only with hypothyroidism and anemia. At the age of 7 years and 8 months, he was admitted to our department with ataxia and abnormal gait from the past year with instability and numerous falls. He also had shown hyperphagia that had been resulted in 10 kilograms of weight gain in six months. He was experiencing gradual behavioral symptoms, including episodes of self and hetero aggression and impulsivity. His other symptoms included fatigue, somnolence, gastrointestinal dysmotility, hyperhidrosis, central hypothyroidism, polyuria, precocious puberty, and rapid obesity. His laboratory investigation revealed hyperprolactinemia. Conclusions: Our case indicates that ROHHAD is a complex disease with divergent signs and symptoms that needs to be kept in mind for diagnosis and should be treated with a high level of collaboration of various medical specialties. Since late diagnosis of this syndrome leads to a magnificent increase in morbidity and mortality rates, it is vital to pay extreme attention to this syndrome. The diagnosis should be considered even more in children over two years old with rapid-onset obesity, which is accompanied by other symptoms. Here, our patient's complaint was ataxia that revealed the underlying cause after investigation.
Background: Congenital pulmonary lesions may be diagnosed through ultrasonographic screenings or be revealed as causes of respiratory distress in the neonatal period and infancy. Less commonly, they are detected as incidental features. Objectives: Our study represents the diversity of congenital pulmonary lesions and their characteristics during an 11-year period in a referral teaching children's hospital in Tehran, the capital city of Iran. Methods: Data from an 11-year period of patients with the final diagnosis of congenital pulmonary lesions in Mofid Children's hospital were reviewed. The data included the prenatal ultrasonographic, postnatal radiographic, and pathologic diagnoses, along with the patient's age, way of presentation, length of hospitalization, and accompanying features and morbidities. Results: Of 37 cases of congenital pulmonary lesions, 28 cases (75%) were boys. Thirty-six cases (97.2%) presented with pure pulmonary signs and symptoms. Of these cases, 16 (43.2%) were neonates, 17 (46%) were infants, and 4 (10.8%) were children. Twentyseven (73%) patients missed the opportunity for early diagnosis. In order of frequency, cases were diagnosed as congenital lobar emphysema (43.5%), congenital cystic adenomatoid malformation (32.5%), pulmonary sequestration (19%), hybrid lesion (2.5%), or bronchogenic cyst (2.5%). Conclusions:In an analysis of retrospective data of 37 congenital pulmonary lesions, male predominance was obvious, as has been found in previous studies.
Introduction: Chronic granulomatous disease (CGD) is a primary hereditary immunodeficiency condition caused by a defect in the nicotinamide adenine dinucleotide phosphate (NADP) oxidase complex. Recurrent infections and inflammatory complications with a narrow bacterial and fungal spectrum characterize CGD. Acute inflammatory and infectious complications are vexing and fatal for them. Therefore, managing CGD with prophylactic antibiotics and antifungal agents is essential. Case Presentation: We present a 23-month-old infant with a chief complaint of recent lymphadenopathy diagnosed with CGD. Two months later, she was hospitalized with uncontrolled fever and lung involvement while receiving prophylactic treatment with trimethoprim/sulfamethoxazole. A mass-like consolidation was seen in her radiography evaluation. Based on the biopsy and bronchoalveolar lavage (BAL) pathology report, pulmonary mucormycosis was confirmed. Two weeks after starting the standard treatment regimen with amphotericin B, the patient’s symptoms improved. She was discharged in good general condition with oral voriconazole and trimethoprim/sulfamethoxazole and referred to do hematopoietic stem cell transplantation (HSCT). Conclusions: Mucormycosis in CGD is not a common infection and usually infects patients with impaired cell-mediated immunity, hematological malignancies, steroid treatment, and diabetes. Patients with CGD are vulnerable when treated with a high dose of immunosuppressant medications. In our case report, the patient was infected with mucormycosis despite not receiving immunosuppressant medications and having no history of hematologic malignancies or diabetes. Our patient also had a mass-like consolidation in her radiological result, a rare feature of pulmonary mucormycosis involvement in CGD patients.
Introduction: A double aortic arch (DAA) is a congenital anomaly of the aortic arch, which is also the most common type of complete vascular ring. This vascular ring can compress the trachea and esophagus, as well as cause respiratory, gastrointestinal, and cardiac symptoms. Case Presentation: In the present case report, a 10-year-old boy with recurrent cough, fever, shortness of breath, chest pain, and a history of recurrent respiratory infections was examined. According to the results of bronchoscopic evaluation, he was found to have a localized tracheomalacia. DAA and dextrocardia condition were also confirmed for this patient by performing a computed tomography angiography of the thorax and the three-dimensional reconstruction of CT angiography. Conclusions: The diagnosis of double aortic arch may be confused with upper respiratory tract infections or foreign body aspiration. Therefore, it was recommended that a particular attention should be paid to the double aortic arch when evaluating cases of stridor in children with unknown causes or recurrent respiratory infections. CT angiography and cardiac MRI were the diagnostic methods of choice for examining vascular rings.
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