Case of cystic fibrosis diagnosed in adolescence

Kistik fibrozis beyaz ırkta en sık görülen otozomal resesif geçişli kalıtsal hastalıktır. "Kistik fibrozis transmembran düzenleyen protein" genindeki değişik mutasyonlar sonucunda hafiften ağıra çeşitli klinik tablolara yol açabilir. Kistik fibrozisli hastalarda akciğer komplikasyonları esas morbidite ve mortalite nedenidir. On yedi yaşında kız hasta öksürük ve balgam çıkarma şikayeti ile polikliniğimize başvurdu. Öyküsü, fizik muayenesi, klinik ve radyolojik bulguları kistik fibrozisi destekler nitelikteydi. İlk ter testi normal gelmişti, tekrarlanan ter testleri yüksek saptandı. Kistik fibroz gen analizi pozitif bulundu. Olguya nebülize alfa-dornaz ve tobramisin tedavileri başlandı, fizik tedavi önerileri anlatıldı ve izleme alındı. Olgu bronşektazili hastalarda kistik fibrozisin akılda tutulması, semptomların geç yaşta başlayabileceği ve ter testinin normal olmasının tanıyı ekarte ettiremeyeceğini vurgulamak amacıyla sunulmuştur. Cystic fibrosis is the most common autosomal recessive hereditary disease in white populations. "Cystic fibrosis transmembrane regulating protein" gene as a result of different mutations can cause mild to severe range of clinical manifestation. The main cause of morbidity and mortality in patients with cystic fibrosis lung complications. Seventeen-year-old girl was admitted to our clinic with complaints of cough and sputum production. History, physical examination, clinical and radiologic findings supported our cystic fibrosis. The first sweat test was normal, repeated sweat tests were higher. Cystic fibrosis gene analysis were positive. The patient was nebulised alpha-Dornase and tobramycin treatments, physical therapy and monitoring were discussed suggestions. A case of cystic fibrosis patients with bronchiectasis keep in mind, symptoms begin in old age and being a normal sweat test are presented in order to emphasize rule out the diagnosis

Evaluation of two cases with round pneumonia

Round pnömoni, akciğer grafisinde yuvarlak konsolidasyon şeklinde sıklıkla çocuklarda görülen bir pnömonidir. Radyolojik olarak pulmoner kitle ile karışması nedeni ile önem teşkil etmektedir. Klinik ve laboratuar bulguları round pnomoni ile uyumlu olan çocuklarda ayırıcı tanı için ileri tetkik edilmeden önce antibiyotik tedavisi sonrası klinik ve radyolojik bulguların tekrar değerlendirilmesi gerekmektedir. Bu sunumda öksürük ve ateş yüksekliği ile başvuran, akciğer grafisinde yuvarlak konsolidasyon saptanan ve tedavi ile kliniği gerileyen iki olgu sunulmuştur. Round pneumonia is a manifestation of pneumonia which seen particular to childhood and it appears as a rounded consolidation on chest x-ray. Radiologically, it is important because of interference with the pulmonary mass. Children whose clinical and laboratory findings are compatible with round pneumonia should be eveluated again after antibiotic treatment before further evaluation for differantial diagnosis. We presented two cases who admitted with cough, fever and round consolidation on chest x-ray and whose clinical and radiological findings regressed after treatment

Pulmonary hydatid cyst disease mimicking necrotizing pneumonia in a child with leukocytoclastic vasculitis

The diagnosis and management of pulmonary hydatid cyst disease represents an important clinical problem in countries of the world that are endemic to echinococcal infection. Atypical clinical and radiologic findings including multiple cavitary lesions in the lung and pleural effusion may lead to misdiagnosis or delay in diagnosis in these patients. We report a patient who was followed up in our hospital with rashes and, clinical and radiologic findings of necrotizing pneumonia in whom there was no response to broad spectrum antibiotherapy. Lung computed tomography showed multiple thick-walled cystic lesions and pleural effusion and the diagnosis of pulmonary hydatid cyst disease was confirmed by surgical and serologic examinations. Antibiotic treatment was changed to albendazole 10 mg/kg/day. There was no liver involvement in terms of cyst hydatid disease with ultrasonographic examination. Skin biopsy showed leukocytoclastic vasculitis. Complete clinical and radiologic improvement was achieved in three months and albendazole treatment lasted six month

Pulmonary hydatid cyst disease mimicking necrotizing pneumonia in a child with leukocytoclastic vasculitis

The diagnosis and management of pulmonary hydatid cyst disease represents an important clinical problem in countries of the world that are endemic to echinococcal infection. Atypical clinical and radiologic findings including multiple cavitary lesions in the lung and pleural effusion may lead to misdiagnosis or delay in diagnosis in these patients. We report a patient who was followed up in our hospital with rashes and, clinical and radiologic findings of necrotizing pneumonia in whom there was no response to broad spectrum antibiotherapy. Lung computed tomography showed multiple thick-walled cystic lesions and pleural effusion and the diagnosis of pulmonary hydatid cyst disease was confirmed by surgical and serologic examinations. Antibiotic treatment was changed to albendazole 10 mg/kg/day. There was no liver involvement in terms of cyst hydatid disease with ultrasonographic examination. Skin biopsy showed leukocytoclastic vasculitis. Complete clinical and radiologic improvement was achieved in three months and albendazole treatment lasted six month

Severe Neck and Face Edema in an Adolescent-Delayed Hypersensitivity Reaction to Hair Dye

Allergic contact reactions to hair dyes arise mostly due to sensitization to para-phenylenediamine (PPD). Para-phenylenediamine, a derivative of p-nitroanaline, is widely used as an oxydizable hair dye and is also found in black henna tattoo. Subsequent exposure to PPD may lead to delayed type IV hypersensitivity reaction manifesting as acute contact dermatitis. Here, a 15-year-old girl is presented, who developed a hypersensitivity reaction after first exposure to hair dye. She was found to have been sensitized to PPD before, through application of black henna tatto

Cold, cholinergic and aquagenic urticaria in children: presentation of three cases and review of the literature

Urticaria can be induced with a wide variety of environmental stimuli, such as cold, pressure, vibration, sunlight, exercise, temperature changes, heat, and water. Urticaria caused by physical factors has been reported as the cause of 6-17% of the chronic urticaria in children. We present three cases here cholinergic, cold and aquagenic urticaria - in which the diagnosis was proven with exercise, ice-cube and water provocation tests, respectively

Idiopathic Cold Urticaria and Anaphylaxis

Cold urticaria (CU) is a subtype of physical urticaria characterized by the development of urticaria and angioedema after cold exposure. Symptoms typically occur minutes after skin exposure to cold air, liquids, and objects. Most common method to confirm the diagnosis of CU is through ice cube challenge test, but 20% of patients with CU have negative ice cube challenge test results. The greatest risk with this kind of urticaria is the development of systemic reaction resulting in a hemodynamic collapse during generalized cold exposure. We report a case of a patient who developed CU and anaphylaxis during swimming and diving in the sea

Midazolam and Ketamine Hypersensitivity in a Four Year Old Child

Hypersensitivity reactions during anesthesia are rarer in childhood when compared with adults. In both children and adults, neuromuscular blocking agents are the most frequently incriminated drugs in this setting followed by antibiotics. Benzodiazepines and ketamine are generally regarded as exceptional drugs regarding allergy. In this report, we present a 4-year old child who developed urticarial lesions during anesthesia and was found to have hypersensitivity to both midazolam and ketamine when diagnostic tests were performed

Efficacy of asthma education program on asthma control in children with uncontrolled asthma

We aimed to evaluate the efficacy of a group education program on asthma control for children with uncontrolled asthma. Patients were randomized to receive 1-hour group education program with their parents or usual care. Our primary outcome was the change in asthma control test (ACT) between baseline and month 3 and secondary outcomes were health care utilizations and self report of exacerbations of asthma symptoms and missed school days. Change of ACT between baseline and 1st month and 3rd month was not significant in education and usual care groups. Health care utilizations and self reported exacerbations in the study groups were similar while missed school days were significantly higher in usual care group. The results of the study suggest that group education may play a useful role in the management of children with uncontrolled asthma but it is not significantly effective when compared with usual care