Ecthyma gangrenosum on the face of a malnourished child with Pseudomonas sepsis: Simulating Cancrum oris

Introduction: Ecthyma gangrenosum (EG) is a cutaneous lesion commonly caused by Pseudomonas aeruginosa that involves mainly the lower limbs and gluteal region, seen more in immunosuppressed patients with neutropenia. Cancrum oris (Noma) is a gangrenous necrosis of the face that begins as a gingival ulcer and progresses rapidly to destroy contiguous tissues in malnourished children. Case Presentation: This article reports a case of facial EG which was similar to Noma in a malnourished child: a 16-month old girl with fever, cough, weight loss, watery stool and swelling on right cheek. She was febrile, pale, wasted with bilateral pitting pedal oedema. She had a solitary circumscribed round necrotic lesion, with surrounding hyperaemia on the right malar area which extended to destroy the right ala nasi. No intra-oral rashes but she had left ear discharge. She received blood transfusion, antibiotics, antiseptic wound care and nutritional rehabilitation. Management and Outcome: Swabs of the lesion and ear discharge both revealed Gram-negative bacilli and culture yielded P. aeruginosa. Retroviral, Mantoux and Gene Xpert tests were negative. She had moderate anaemia, normal white blood cell count, and neutropaenia. Parenteral ceftriazone was changed to ciprofloxacin based on sensitivity results and lack of clinical response. The wound healed with residual scarring and partial destruction of right ala nasi. Discussion: Although this patient had facial necrosis to suggest Noma, she did not have initial oral involvement, and clinical features such as Pseudomonas sepsis and neutropaenia suggested EG. Facial necrosis in malnourished children may be due to EG

Prevalence and Determinants of Endothelial Dysfunction among Adults Living with HIV in Northwest Nigeria

Background: Endothelial dysfunction constitutes an early pathophysiological event in atherogenesis and cardiovascular disease. This study aimed to assess the prevalence, determinants, and degree of endothelial dysfunction in antiretroviral therapy (ART)–treated people living with HIV (PLWH) in northwestern Nigeria using brachial flow-mediated dilatation (FMD). Methods: This was a comparative, cross-sectional study. A total of 200 ART-treated adults living with HIV with no evidence of kidney disease were compared with 200 HIV-negative participants attending a tertiary hospital in Kano, Nigeria, between September 2020 and May 2021. Endothelial function was evaluated by measuring FMD with a high-resolution vascular ultrasound transducer. FMD was calculated as the ratio of the brachial artery diameter after reactive hyperemia to baseline diameter and expressed as a percentage of change. Blood and urine samples were obtained from participants in both arms. Urine albumin-to-creatinine ratio (uACR) was calculated using the 2021 CKD-EPI estimated glomerular filtration rate (eGFR) creatinine-cystatin C equation without the race variable, and low-density lipoprotein (LDL) cholesterol was measured using enzymatic method. Results: The overall mean age (± standard deviation) of the study participants was 42 ± 11 years. Participants in the comparison arm were younger than PLWH (38 ± 11 versus 46 ± 10 years, respectively). The median (interquartile range) uACR was 41.6 (23.2–162.9) mg/g for the ART-treated PLWH versus 14.5 (7.4–27.0) mg/g for healthy controls. PLWH had a significantly lower mean percent FMD when compared to HIV-negative participants (9.8% ± 5.4 versus 12.1% ± 9.2, respectively). Reduced FMD was independently associated with HIV infection (β = –2.83%, 95% CI, –4.44% to –1.21%, p = 0.001), estimated glomerular filtration rate (β = –0.04%, 95% CI, –0.07% to –0.01%, p = 0.004) and LDL cholesterol (β = –1.12%, 95% CI, –2.13% to –0.11%, p = 0.029). Conclusion: HIV-positive status, lower estimated GFR, and higher LDL cholesterol levels were independently associated with endothelial dysfunction. Future prospective studies with larger cohorts of persons living with HIV (and age- and sex-matched HIV-negative controls) are needed to gain further insight into these important findings. In the interim, aggressive management of modifiable risk factors is warranted

Wilms' Tumour in a Child with Horse Shoe Kidney seen at Usmanu Danfodiyo University Teaching Hospital, Sokoto- A Case Report

Background- Occurrence of Wilms' tumour in patients with horseshoe kidney is an unusual presentation, with incidence being higher than in the general population. Hence, it can lead to diagnostic and management challenges.Objective- To report a case of Wilms' tumour that occurred in a child with horse shoe kidney in Usmanu Danfodiyo University Teaching Hospital (UDUTH), Sokoto.Case report- UA an 18 month old boy presented with a six weeks history of progressive painless abdominal swelling. Abdominal examination revealed a huge right sided abdominal mass extending from the hypochrondium to the iliac fossa. Ultrasound revealed a huge heterogenous mass occupying the right hemi-abdomen extending from the right hypochondrium to pelvis. It crossed the midline to the contralateral side with multiple cystic portions and calcifications. The right kidney was not demonstrated while the left kidney was normal. Computed tomography (CT) scan showed a huge heterogeneously enhancing isodense mass occupying most part of the right lumbar region extending to the pelvis and crossing the midline. The mass was continuous with normal renal parenchyma on the inferomedial aspect consistent with Wilms' tumour. The inferior poles of both kidneys were merged in the midline in keeping with horse shoe kidney. Chemotherapy was commenced however he deterioratedand died after 2 courses.Conclusion- Wilms' tumour can occasionally occur in a child with horse shoe kidney. Hence, patients with horseshoe kidney should therefore be closely monitored for the possibility of co-existing Wilms' tumour.Key words- Horse shoe kidneys, Wilms' tumour, Child, diagnostic challenge

A 5-year review of measles cases admitted into the emergency paediatric unit of a tertiary hospital in Sokoto, North-Western Nigeria

Background: Measles is a vaccine preventable viral infection which is still responsible for significantly high morbidity and mortality in Sub-Saharan Africa. Failure of routine immunization programs heralds a dismal outlook for this potentially eradicable viral infection. The objective of this study was to determine the hospital prevalence, vaccination status, pattern of complications, and outcome of children admitted with measles into the Department of Pediatrics of Usmanu Danfodiyo University Teaching Hospital, Sokoto, Nigeria. Materials and Methods: This was a 5-year retrospective study from January 1, 2011 to December 31, 2015. Case folders of children below 15 years who were admitted with measles were retrieved, relevant information extracted, and entered into a pro forma. Data was analyzed using SPSS version 22. Results: Total admissions were 6104, out of which 204 were due to measles (prevalence, 3.3%). The mean age was 27.4 ± 18.9 months (range 6–96 months). Those aged 1–5 years were 144 (70.6%). The male-to-female ratio was 1.3:1. Only 28 patients (13.7%) had measles vaccination. Observed complications included bronchopneumonia in 168 (82.4%), acute laryngotracheobronchitis in 24 (11.8%), febrile convulsion in 20 (9.8%), encephalitis in 17 (8.3%), ocular complications in 12 (5.9%), and suppurative otitis media in 6 (2.9%) patients. The presence of complications was related to age <5 years (P = 0.0001) but not to vaccination status (P = 0.41). Forty-four patients died (21.6%), whereas 33 patients (16.2%) had residual problems at discharge. Outcome was related to vaccination status (P < 0.05). Conclusion: Measles is still a significant problem in the study area and it is associated with high morbidity and mortality. More efforts at prevention is necessary