Carpal spasm in a girl as initial presentation of celiac disease: a case report

Abstract Background Celiac disease is an immune-mediated disorder elicited by ingestion of gluten in genetically susceptible persons. This disorder is characterized by specific histological changes of the small intestine mucosa resulting in malabsorption. This case was written up as it was an unusual and dramatic presentation of celiac disease. Case presentation We report the case of a 3-year-old Albanian girl who presented at our clinic with carpal spasms and hand paresthesia. A physical examination at admission revealed a relatively good general condition and body weight of 10.5 kg (10 percentile). Carpal spasms and paresthesias of her extremities were present. Neuromuscular irritability was demonstrated by positive Chvostek and Trousseau signs. Blood tests showed severe hypocalcemia with a total serum calcium of 1.2 mmol/L (normal range 2.12 to 2.55 mmol/L), ionized calcium of 0.87 (normal range 1.11 to 1.30 mmol/L), and 24-hour urine calcium excretion of 9.16 mmol (normal range female <6.2 mmol/day). Among other tests, screening for celiac disease was performed: antigliadin immunoglobulin A, anti-tissue transglutaminase, and anti-endomysial immunoglobulin A antibodies were positive. A duodenal biopsy revealed lymphocyte infiltration, crypt hyperplasia, and villous atrophy compatible with celiac disease grade IIIb according to the Marsh classification. Following the diagnosis of celiac disease, human leukocyte antigen typing was performed, giving a definite diagnosis of celiac disease. She was started on a gluten-free diet. Due to failure to follow a gluten-free diet, episodes of carpal spasms appeared again. Unfortunately, at the age of 7 years she presents with delayed psychophysical development. Conclusions Although hypocalcemia is a common finding in celiac disease, hypocalcemic carpal spasm is a rare initial manifestation of the disease. Therefore, the possibility of celiac disease should be considered in patients with repeated carpal spasms that seem unduly difficult to treat. This should be evaluated even in the absence of gastrointestinal symptoms since hypocalcemia and its manifestation may present as initial symptoms of celiac disease even in young children

Acute poisoning in children; changes over the years, data of pediatric clinic department of toxicology

Objective: To present the frequency, etiology, changes over the years of acute poisoning in children admitted to Pediatric Clinic of Pristina and to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. Methods: Retrospectively we have analyzed the epidemiology of accidental and suicidal poisonings in children hospitalization in Pediatric Clinic Department of Toxicology during the year 2012. Our data we compared with data from previous studies on acute poisoning in children in the Pediatric Clinic conducted during the years 1976–1985 and 2001. Results: During the year 2012, in Pediatric Clinic of Pristina 5 723 children were hospitalized, 136 of them or 2.3% were treated due to acute poisoning in Department of Toxicology, 82 of them was boys and 54 was girls, rate boys girls was 1.5:1. The majority of cases 101 or 74.2% were under five years with peak age three and 35% or 25.7% were over five years. The most of the cases was accidentally 97% and only 2.9% was suicidal and all of them were over the age of ten. Drugs were the most common agent causing the poisoning 71 (52.2%) followed by house cleaning products 38 (27.9%), food 10 (5.8%), pesticides 7 (5.14%), rare agent that caused poisoning were: narcotic substances, plant, heavy metals, alcohol, carbon monoxide, carburant. Poisoning occurred mostly in spring and the peak was observed in May, (1.17% of all patients). January was the month of lowest rate of poisoning. During the years 1976–1985, in Pediatric Clinic of Pristina 900 children were hospitalized due to acute poisoning, 44.11% were from drugs, 15.88% from pesticides, 65 (7.2%), while during 2001 in the unit care intensive were hospitalized 66 children due to acute poisoning, among them 51.5% were poisoning from drugs, 30.03 from pesticides, 12.2% from cleaning products. Conclusion: In our study drugs and house cleaning products are the most frequent agents causing accidental poisoning in children less than 5 years-old, this age of children is the most susceptible in terms of morbidity. Compared with the previous studies in Pediatric Clinic of Pristina, drugs are still the most frequent cause of acute poisoning in children; the number of poisoning with pesticides has fallen but has increased the number of poisoning with cleaning products. All preventive measures against poisoning should be taken including preventive strategies of education at national level especially in drug and household product storage