A Case of Dengue Fever Complicated with Trombophlebitis in a Child

Dengue fever is a disease characterized by flu like symptoms which is endemic in tropic and subtropic regions. Dengue virus is from Filavivirus family. Dengue fever is rarely seen in our country. Hemorrhagic and thrombotic complications can be observed during the course of the disease. Herein we present a child case of Dengue fever diagnosed in our country who was complicated with thrombophlebitis. A previously healthy 16-year old boy was presented with headache, malaise and fever lasting for six days. He had returned from Philippines a week ago where he had stayed for a month. On physical examination, he was dehydrated with fever of 39.3 degrees C. His heart rate was 109/min, respiratory rate was 28/min, blood pressure was 132/78 mmHg, oxygen saturation was %96 (room air) and capillary refill time was 5 seconds. His oral mucosa was dry and turgor was decreased. He had generalized erythematous rash, muscle pain and 2 cm splenomegaly. Laboratory examination revealed polycythemia and thrombocytopenia. He was hospitalized and intravenous hydration was initiated because of severe dehydratation and hemoconcentration. His history revealed that his roommate in Philippines was diagnosed as Dengue fever, recently. Pain and limitation of movement on left antecubital region developped on follow-up. Peripheral pulses could be palpated on both distal extremities and there was no difference of heat. Superficial doppler ultrasonography revealed echogenic thrombus extending from cephalic vein to wrist, and basilic vein to axillary region without recanalization. He was started on enoxaparin treatment. Serum Dengue fever IgM and IgG were reported as positive and he was discharged with recovery one week after hospitalization. Dengue fever should be considered as differential diagnosis of patients with flulike symptoms who had travel history to endemic countries. Hemorrhagic complications and hemorrhagic shock syndrome which are frequently seen in patients with Dengue fever can cause mortality. In addition, superficial and deep vein thrombosis can be observed in severely dehydrated patients with Dengue fever. These patients should be carefully observed for possible thromboembolic complications

Shear wave elastography of parotid glands in pediatric patients with HIV infection

ObjectivesParotid gland (PG) involvement is common among the patients with HIV infection. Shear wave elastography (SWE) is a noninvasive method used to measure the tissue stiffness of several organs including PG. The aim of this study was to evaluate the tissue stiffness values of PGs of HIV-infected children via SWE and compare the results with the counterparts of healthy subjects.Materials and methodsThis single-center, prospective study included the PG examinations of 23 pediatric HIV patients and 40 healthy children via grayscale ultrasound and SWE. Independent sample T test and Mann-Whitney U test were used in statistical analysis.ResultsStiffness of both PGs was significantly higher in patients' group when compared with control subjects. In addition, when the patients were separated into two groups according to the appearance of PG on grayscale ultrasound as homogeneous and heterogeneous, stiffness values were increased in the patients with homogeneous parenchymal appearance. No significant difference was achieved in terms of median CD4 and CD8 counts, HIV RNA levels or median duration of illnesses.ConclusionsPG examination of HIV-infected children via SWE reveals increased tissue stiffness when compared with healthy subjects. SWE can be used as an ultrasound-assisted noninvasive technique in this manner

Comparative evaluation of liver, spleen, and kidney stiffness in HIV-monoinfected pediatric patients via shear wave elastography

Background/aim: This study aimed to evaluate the stiffness of the liver, spleen, and kidneys in HIV-monoinfected children via shear wave elastography (SWE)

Necrotizing Pneumonia in a Diabetic Child Successfully Treated with Pneumonectomy

Diabetic patients may experience more severe Staphylococcus aureus-related respiratory tract infections such as necrotizing pneumonia (NP). A 13-year-old girl with uncontrolled diabetes mellitus was admitted to pediatric intensive care unit (PICU) with diabetic ketoacidosis and respiratory distress. Her initial evaluation revealed diffuse pneumonic infiltration that progressed to NP within days. She was intubated and placed on mechanical ventilator (MV) support. Positive inotropes and broad-spectrum antibiotics were initiated. Methicillin-resistant S. aureus was isolated from blood and pleural specimen cultures. In spite of aggressive medical treatment, infection could not be controlled and lobectomy was performed. However, the patient was fistulized and right total pneumonectomy was performed on the 16th and 29th days of PICU admission. She gradually got better and was weaned from MV. On the 59th day, she was discharged oxygen-free from the hospital. Early surgical intervention should be considered for the treatment of NP resistant to medical therapy