The Case | Ectopic calcifications in a child

The case A nine year old boy, born of third degree consanguinity, presented with a hard left scapular swelling for 6 months. There was no history of fever, trauma or weight loss. There was no pain, redness or discharge. This mass was excised but recurred over the next 6 months (Left panel of Figure 1). A similar swelling had been excised from the left knee one year before presentation, but had recurred over 6 months. Family history was negative for similar lesions. Development was normal for age and he had no other medical problems. On examination, pulse was 84 per minute, blood pressure 96/68 mmHg, weight 22 kg and height 122 cm (both between 10th and 25th percentile). A 6 × 4 cm mass was noted in the right scapular region and a 3 × 3 cm mass at the lateral aspect of the left knee. Both of these masses were firm to hard, globular, nontender, and fixed to the bone. The overlying skin was without erythema or local warmth, though scars from the previous resections were noted. Lymphadenopathy was absent. The rest of the examination was unremarkable. Radiographs of the knee showed a lobular, inhomogenously but densely calcified lesion in the anterolateral region of the left knee (Right panel of Figure 1). Serum calcium was 9.

A case of bronchiolitis obliterans in a young child

Bronchiolitis obliterans (BO) is an infrequent chronic obstructive pulmonary disease that follows an insult to lower respiratory tract. BO following a severe lung infectious disease is the most common form reported in children. It implies a chronic necrotizing and ultimately fibrosing process affecting the small airways which results in progressive obliteration with resultant obstructive lung disease. The characteristic symptom-complex includes dyspnea, chronic cough, sputum production and wheezing. Although histopathology remains the gold standard for diagnosis, computed tomographic scan is of great help in diagnosis. Etiological role of mechanical ventilation has not yet been studied well. We report a case of BO in a three year old child occurring after an episode of lower respiratory tract infection requiring prolonged mechanical ventilation with subsequent development of ventilator-associated pneumonia. Our patient had a protracted clinical course with good response to corticosteroids

A case of bronchiolitis obliterans in a young child

Bronchiolitis obliterans (BO) is an infrequent chronic obstructive pulmonary disease that follows an insult to lower respiratory tract. BO following a severe lung infectious disease is the most common form reported in children. It implies a chronic necrotizing and ultimately fibrosing process affecting the small airways which results in progressive obliteration with resultant obstructive lung disease. The characteristic symptom-complex includes dyspnea, chronic cough, sputum production and wheezing. Although histopathology remains the gold standard for diagnosis, computed tomographic scan is of great help in diagnosis. Etiological role of mechanical ventilation has not yet been studied well. We report a case of BO in a three year old child occurring after an episode of lower respiratory tract infection requiring prolonged mechanical ventilation with subsequent development of ventilator-associated pneumonia. Our patient had a protracted clinical course with good response to corticosteroids

Clinical course and outcomes of COVID-19 in kidney transplant recipients

Introduction: Kidney transplant recipients (KTR) are at increased risk of morbidity and mortality due to coronavirus disease 2019 (COVID-19). This study aimed to explore the clinical characteristics and outcomes of COVID-19 in KTR. Methods: We reviewed the clinical profile, outcomes, and immunological responses of recipients admitted with COVID-19. We determined the risk factors for mortality and severe COVID-19. Results: Out of 452 recipients on follow-up, 60 were admitted with COVID-19. Prevalent comorbidities were hypertension (71%), diabetes (40%), lung disease (17%). About 27% had tuberculosis. The median Sequential Organ Failure Assessment score at presentation was 3 (interquartile range [IQR] 1–5). There was a high incidence of diarrhea (52%) and anemia (82%). Treatment strategies included antimetabolite withdrawal (85%), calcineurin inhibitor decrease or withdrawal (64%), increased steroids (53%), hydroxychloroquine (21%), remdesivir (28.3%), and tocilizumab (3.3%). Severe COVID-19 occurred in 34 (56.4%) patients. During a median follow-up of 42.5 days (IQR 21–81 days), 83% developed acute kidney injury (AKI) and eight (13%) died. Mortality was associated with the baseline graft dysfunction, hypoxia at admission, lower hemoglobin and platelets, higher transaminases, higher C reactive protein, diffuse radiological lung involvement, hypotension requiring inotropes, and Kidney Diseases Improving Global Outcomes (KDIGO) stage 3 AKI (univariate analysis). Around 57% of patients remained RT-PCR positive at the time of discharge. By the last follow-up, 66.6% of patients developed IgM (immunoglobulin M) antibodies and 82.3% of patients developed IgG antibodies. Conclusion: COVID-19 in kidney transplant recipients is associated with a high risk of AKI and significant mortality