Systemic histoplasmosis has various clinical presentations and is of especially concern in immunocompromised patients. A high index of suspicion is required for its diagnosis. A total of 38 cases had been reported from India up to 1996. The most frequent occurrence of cases was around Calcutta in eastern India where the previous case was detected 20 years earlier. However, we have diagnosed 5 cases in the past 2 years from eastern India which are reported here. These cases may indicate under-diagnosis and under-reporting of histoplasmosis in India. All 5 patients had disseminated disease with multisystem involvement including 2 with bilateral adrenal enlargement. Two were diabetic and only 1 patient was infected with HIV.

Extramedullary hematopoiesis (EMH) refers to hematopoiesis occurring outside the medulla of bone. It may be physiologic or due to pathological conditions like hematopoietic disorders. EMH can involve liver, spleen, thorax, and lymph nodes. It can involve paraspinal tissues with extension and involvement of spinal canal. In our case, the diagnosis was confirmed by the history of the patient stating underlying hematological condition and by magnetic resonance imaging (MRI) findings showing large soft tissue masses in paraspinal areas with involvement of spinal canal and leading to cord compression.

Langerhans cell histiocytosis (LCH) is a relatively rare disease affecting the reticuloendothelial system in the pediatric age group. It can affect bones, lung, liver, spleen, lymph nodes and skin. MR imaging is particularly informative in diagnosis and management of bone LCH. In this report, we present the initial and 23 months post-treatment MR images of a femoral LCH lesion in a 12-year-old child to describe the role of MRI in bone LCH.

Introduction: Scrub typhus is an acute febrile illness caused by infection with rickettsial bacilli Orientia tsutsugamushi. This was a retrospective observational study to study the clinical profile of paediatric scrub typhus, its associated complications and response to treatmentMaterial and Methods: Record files of all patients diagnosed with positive Weil felix (OXK>1:80) and Scrub IgM positive over a period of one year were analysed. Total of 10 cases were diagnosed as scrub with median age of presentation 4.1 years.Results: Fever was present in all followed by pain abdomen (50%), rash. Anaemia (90%), lymphadenopathy (70%) hepatomegaly (100%), Leukopenia was present in those cases with fever <1 week while leucocytosis was found thereafter. Most common complication were hepatitis (100%) shock (50%), acute kidney injury (AKI) 30%, DIC in 20% cases. Secondary HLH was found in 20% and pancarditis in one case. All the cases showed dramatic response to doxycycline.Conclusion: So a high index of suspicion is required to diagnose scrub and early initiation of treatment is essential to prevent mortality from the disease.

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Kawasaki Disease is the most common cause of acquired heart disease in the developed countries. The diagnosis of typical Kawasaki Disease (KD)is not much of a problem. However incomplete Kawasaki Disease where only two to three clinical features are present, poses a diagnostic dilemma. Here we report our experience with the disease in the paediatric department of Vivekananda Institute of Medical Sciences (VIMS). In one year retrospective study from Jan 2015 to Jan 2016, 20 cases were diagnosed as KD, of which five were complete and 15 incomplete. Fifty percent of cases were less than one year’s age and there was male preponderance. More than 90% showed echo changes and all except one responded to IVIG and aspirin who succumbed due to aneurysm rupture. So we conclude that high index of suspicion for diagnosing KD must be there and early treatment to prevent echocardiographic changes.J Nepal Paediatr Soc 2016;36(2):208-212

Haemophagocytic syndrome caused by CMV infection in a one month old infant is rare. Cytomegalovirus can cause congenital or perinatal infection in an infant. We report a case in a baby who had secondary haemophagocytic syndrome.The baby had progressive pancytopenia, hepatosplenomegaly and diagnosed to be infected with CMV. Inspite of aggressive management the baby succumbed to death. CMV infection in a neonate may predispose to haemophagocytic syndrome.