Hyperinsulinaemic hypoglycaemia (HH) is the most common cause of persistent hypoglycaemia in infants and children with incidence estimated at 1 per 50,000 live births. Congenital hyperinsulinism (CHI) is symptomatic mostly in early infancy and the neonatal period. Symptoms range from ones that are unspecific, such as poor feeding, lethargy, irritability, apnoea and hypothermia, to more serious symptoms, such as seizures and coma. During clinical examination, newborns present cardiomyopathy and hepatomegaly. The diagnosis of CHI is based on plasma glucose levels <54 mg/dL with detectable serum insulin and C-peptide, accompanied by suppressed or low serum ketone bodies and free fatty acids. The gold standard in determining the form of HH is fluorine-18-dihydroxyphenyloalanine PET ((18)F-DOPA PET). The first-line treatment of CHI is diazoxide, although patients with homozygous or compound heterozygous recessive mutations responsible for diffuse forms of CHI remain resistant to this therapy. The second-line drug is the somatostatin analogue octreotide. Other therapeutic options include lanreotide, glucagon, acarbose, sirolimus and everolimus. Surgery is required in cases unresponsive to pharmacological treatment. Focal lesionectomy or near-total pancreatectomy is performed in focal and diffuse forms of CHI, respectively. To prove how difficult the diagnosis and management of CHI is, we present a case of a patient admitted to our hospital.
COVID-19 neurological manifestations vary from mild symptoms, such as fatigue, to severe complications. This article presents a case of a 15-year-old male with multiple brain abscesses, meningitis, massive sinusitis and saggital sinus thrombosis. SARS-CoV-2 IgM and IgG antibodies were increased, while blood and CSF cultures, anti-HSV antibodies and IGRA were negative. The patient responded well to the initial treatment with broad-spectrum antibiotics, glucocorticoids and intravenous immunoglobulins. After two weeks, his clinical state sudd0enly collapsed, with the progression of purulent lesions in the MRI. Urgent craniotomy was performed. A follow-up MRI confirmed regression of the purulent lesions. Negative blood and CSF cultures, as well as insufficiency of the broad-spectrum antibiotic therapy, suggested an atypical or opportunistic CNS infection, characteristic of immunocompromised patients. This strengthens the hypothesis that SARS-CoV-2 infection may lead to decreased immunocompetence.
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