A 14-year-old Tahitian girl with acute myeloid leukaemia and a suspected mucormucosis infection was treated with intravenous voriconazole and caspofungin. Because of worsening of fungal infection, voriconazole was switched to posaconazole. During the switch, the patient presented with QT interval prolongation with 'torsades de pointes' and reversible cardiac arrest. Voriconazole plasma level measured 15 h after the last administration was 7 mg/L. Genotyping suggested that the patient was an extensive metabolizer with respect to CYP2C9 and CYP2C19. The association of antifungal agents with pro-arrhythmogenic drugs and other risk factors led to torsades de pointes and the revealing of inherited QT syndrome.

We report the case of a large leg tumor in a fetus at 36 weeks of gestation. The tumor 's location, ultrasound CASE REPORTA 31-year-old woman, gravida 2 para 0, was referred to our hospital after a third ultrasound examination at 36 weeks of gestation revealed a large tumor on the right leg of the fetus (Figure 1a). The patient had conceived spontaneously and had no family history of any malformation. This anomaly was not present on previous ultrasound examinations. The tumor measured 90 × 80 mm and was poorly vascularized. The fetal middle cerebral artery peak systolic velocity was normal. A male fetus of normal size was observed in the footling breech presentation, with no other structural abnormalities. Magnetic resonance imaging (MRI) examination using 1.5 Tesla (IRM MAGNETOM Avanto, Siemens, Erlangen, Germany) at 37 weeks of gestation showed a 107 × 73 × 86-mm soft tissue mass around the tibia and fibula (Figure 1b,c). The tumor presented as a well-demarcated low-signal-intensity soft tissue mass on T1-weighted imaging and as an inhomogeneous high-signal-intensity soft tissue mass on T2-weighted imaging and TrueFISP sequences. The mass lay adjacent to the bones and deformed the foot and leg, but there was no cortical destruction or marrow involvement. No evidence of metastatic spread was found on whole-body MRI 1,2 . All ultrasound and MRI findings were compatible with an infantile fibrosarcoma. The parents were informed and initially decided on termination of pregnancy. We submitted the medical records to the pediatric oncology department and to the prenatal diagnosis center. Termination of pregnancy was not accepted because of the excellent prognosis of such a tumor, with complete remission in 80% of patients and a 5-year survival rate of 90% after treatment 3 .The same operator performed another ultrasound examination 1 week later to evaluate the tumor progression: the vascularized mass had grown to 120 mm without fetal anemia. The fetus was still in the footling breech position. Because the pregnancy was now at 38 weeks of gestation, a Cesarean section was scheduled. On the day of admission, the patient reported no fetal movements. Fetal heart rate had slowed markedly. A male infant in the cephalic position was delivered by emergency Cesarean. Birth weight was 3380 g, the 1-and 5-min Apgar scores were 2 and 4, respectively, and the umbilical artery pH was 7.21. The amniotic fluid was bloody. Hemorrhagic shock caused by an oval-shaped red-blue tumor, not covered with skin, surrounding the right leg (Figure 1d) was treated immediately. During the first day (hour 6 after delivery) and despite appropriate care, it was decided to amputate the lower leg because of uncontrolled bleeding. Seven days later, neurological

We report the case of a 5-year-old child with dyskeratosis congenita who presented cyanosis and dyspnea at exertion. He had severe hypoxemia with elevated alveolar-arterial oxygen gradient in the setting of liver disease. Technetium-99m-labeled macroaggregated albumin scan showed abnormally high uptake in the brain, confirming hepatopulmonary syndrome.

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