Background and Aims: Fecal microbiota transplantation (FMT) has been increasingly studied in the inflammatory bowel disease (IBD) population. However, most studies have focused on the adult population, and the safety and efficacy of FMT in a pediatric population is less well understood. This systematic review and meta-analysis investigates the safety and efficacy of FMT in a pediatric IBD population. Methods: A comprehensive literature search of publications published prior to 30 June 2022 was undertaken. Safety data, IBD-related outcomes, and microbiome analysis were obtained from these studies when accessible. Individual estimates of each study were pooled, and sensitivity analysis was conducted. Results: Eleven studies satisfied our eligibility criteria. The calculated pooled rate of adverse events was 29% (95% confidence interval [CI]: 15.0%, 44.0%; p < 0.001; I2 = 89.0%, Q = 94.53), and the calculated pooled rate of serious adverse events was 10% (95% confidence interval [CI]: 6.0%, 14.0%; p = 0.28; I2 = 18.0%, Q = 9.79). One month after FMT, clinical response was achieved in 20/34 (58.8%) pediatric IBD patients, clinical remission was achieved in 22/34 (64.7%), and both clinical response and remission were achieved in 15/34 (44.1%) pediatric IBD patients. Conclusions: FMT can be a safe and effective treatment in the pediatric IBD population and may demonstrate improved safety and efficacy in the pediatric population compared to the adult population. However, our results are limited by a lack of established protocol as well as long-term follow-up for FMT in a pediatric IBD population.
Neurosarcoidosis is a rare, chronic inflammatory disease that affects the nervous system. It is diagnosed in 5 to 10% of sarcoidosis patients, but has been found in 25% of autopsies. This suggests that a large percentage of patients are asymptomatic or misdiagnosed. Diagnosis is difficult due to variable expressivity and overlap of symptoms with other neurological disorders, such as multiple sclerosis. Moreover, diagnosis proves challenging because currently, the most specific test for neurosarcoidosis requires a histological biopsy confirmation of the affected neural tissue. This presents with its own complications. Due to the lack of fixed diagnostic methods and symptom overlap, a multidisciplinary approach is recommended in diagnosing a patient with possible neurosarcoidosis. This case describes the difficulty in making the diagnosis and the persistence of the patients physicians.
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