Colonic basidiobolomycosis in a child: report of a culture-proven case

SummaryBasidiobolomycosis is a rare fungal disease caused by Basidiobolus ranarum, which is endemic in tropical and subtropical regions of Africa, Asia, and Latin America. Gastrointestinal basidiobolomycosis poses diagnostic difficulties due to the non-specific clinical presentation and absence of predisposing factors. Eight pediatric cases of the disease have been reported recently from Iran, but none of these, or most of the other cases reported in the literature, has been proven by culture, which is the gold standard method for diagnosis. We present a case of culture-proven colonic basidiobolomycosis that occurred in a 3-year-old boy. The outcome was successful following surgical excision and antifungal therapy with posaconazole

Intestinal Parasites in Children with Lymphohematopoietic Malignancy in Iran, Mashhad

Background: Intestinal parasitic disease can cause serious complications for Immunosuppressed patients. Objectives: This study determines the prevalence of intestinal parasites in children, with lymphohematopoietic malignancy in Mashhad, Iran. Patients and Methods: In this cross-sectional study stool samples were collected from 89 children (53 boys, 36 girls) with lymphohematopoitic malignancies under chemotherapy, between the age of 1 and 18 years (mean age 7.5 years). Three fresh stool samples taken for three consecutive days were examined by direct smear, formalin-ether method, trichrome staining and ELISA test for Giardia lamblia coproantigens. Results: In this study 35.9% of our patients had parasitic infections and the following parasites were identified; G. lamblia (the most prevalent parasite in children) 16 (18%), Entamoeba coli 6 (6.7%) Blastocystis hominis 5 (5.6%) Iodamoeba butschlii 2 (2.2%). Chilomastics mesnili 1 (1.1%), Hymenolepis nana 1 (1.1%) and Enterobius vermicularis 1 (1.1%). Conclusions: With regards to the high incidence of gasterointestinal parasitic diseases and also because of asymptomatic cases of giardiasis, we recommend evaluation of pediatric patients with malignant lymphohematopoitic disease by at least two different diagnostic methods and three rounds of stool examination in order to prevent possible life threatening outcomes. Coproparasitoscopic study for oncologic patients should be performed and anti-parasitic treatment provided before starting chemotherapy to prevent disseminated parasitic infections. The coproantigen-ELISA is especially advantageous in situations where only a single stool sample can be examined

Omental-Mesenteric Myxoid Hamartoma Mimicking Malignancy in a 14-month-old child (A Case Report)

Background: The omental-mesenteric myxoid hamartoma (OMMH) is a very rare lesion, mainly seen in children and characterized by multiple omental and mesenteric nodules, which may be confused with malignant neoplasm. Microscopically, these lesions consist of a richly vascularized myxoid stroma with plump mesenchymal cells. This lesion has a benign clinical course without recurrence during follow up. Case Presentation: We present a 14-month-old boy that was referred with history of abdominal distension, fever and vomiting for 3 months. Enhanced computed tomography (CT) revealed a huge well-demarcated hypodense and spherical mass which displaced bowel loops without obvious penetration to the intestinal walls.Histological and immunohistochemical examinations confirmed the diagnosis of OMMH.No evidence of recurrence was noted during 3 years follow up. Conclusion: OMMH is a very rare lesion and because of its aggressive appearance, differential diagnosis with malignancy is warranted. The clinical picture of our case also led to high suspicion of malignancy. However by consideration of histological and immunohistochemical findings we could achieve the correct diagnosis

ANCA-Negative Pulmonary-Renal Syndrome with Pathologic Findings Suggesting Thrombotic Thrombocytopenic Purpura

Background: Thrombotic thrombocytopenic purpura (TTP) is a rare disease characterized by microangiopathic hemolytic anemia, thrombocytopenia, neurologic abnormalities, fever and renal dysfunction. The disease classically spares the lung tissue, but recently some cases were reported that presented with respiratory involvement (adult respiratory distress syndrome or pulmonary-renal syndrome). Presentation with pulmonary-renal syndrome has rarely been reported. Case Presentation: We report a 14-yaers-old boy admitted to the hospital because of a biochemical evidence of renal failure. Two days after admission he developed a high fever, hemoptysis and respiratory distress. Open kidney biopsy was performed and confirmed the diagnosis and finally the patient expired due to neurologic involvement. Conclusion: This case is presented to discuss the need to update the criteria for TTP diagnosis and considering TTP in the differential diagnosis of pulmonary renal syndromes

Fibrous hamartoma of infancy, Report of Two Cases

Objective: Fibrous hamartoma of infancy (FHI) is a rare, benign soft tissue tumor that typically occurs within the first two years of life. It has a specific histologic appearance comprising of three different mesenchymal tissues with variable proportions in an organoid fashion. The clinical course is typically benign with excellent prognosis. We report two cases of this rare lesion and review its cilinicopathologic characteristics. Case Presentation: The first case was a 15-month-old girl who had a subcutaneous mass in the right axillary region and the other one was an 18-month-old boy with a mass on the medial surface of his right ankle. The masses were successfully excised. After 6 and 30 months follow up no recurrence occurred. Conclusion: Although the clinical and imaging findings of FHI are quite similar to those of malignant soft tissue tumor, histologic characteristics of this tumor will guide to the definite diagnosis that will prevent aggressive and mutilating procedures

Multiple Congenital Epulis of the Mandibular Ridge: A Case Report

Congenital epulis is a very rare benign soft-tissue tumor of uncertain histogenesis, which is also known as “gingival granular cell tumor of the newborn”. It occurs almost exclusively as a single tumor along the alveolar ridge of the maxilla in newborn females. Although congenital epulis is strikingly similar to the more common adult granular cell tumor histologically, in contrast to the latter congenital epulis cells are negative for S-100 protein. This case report describes a 15-day-old female infant with multiple congenital epulis of the mandibular alveolar ridge

Rapidly progressive nephromegaly in a neonate with autosomal recessive poly cystic kidney disease

Background: Autosomal recessive polycystic kidney disease (ARPKD) associates with significant renal and liver-related morbidity and mortality in children. Rarely severe enlargement of kidneys necessitates nephrectomy and initiating dialysis. Case Presentation: A 5-day-old newborn boy with prenatal ultrasonography suggestive of ARPKD admitted in the hospital due to anuria from first day of life. One week after admission, left nephrectomy was conducted because of severe enlargement of kidneys accompanied by respiratory distress and repeated vomiting. Patient was placed on peritoneal dialysis. Pathology of kidney revealed cystic lesions consisted of dilated collecting duct, with lack of involvement of glomeruli and other parts of the nephrons. Patient died at age 17 days with respiratory hemorrhage. Conclusions: Our case is interesting because of progressive increase in kidney sizes requiring nephrectomy. Such huge nephromegaly in ARPKD has not been reported yet

Heterotopic Oral Gastrointestinal Cyst: Report of Two Cases

Introduction: Heterotopic gastrointestinal cyst of the oral cavity is an extremely rare lesion with fewer than 40 cases reported in the English literature. It usually involves the soft tissue covering the floor of the mouth and the tongue. Lining of this lesion resembles gastric or intestinal mucosa. Case Report: In this report we describe the lesion in two boys and discuss their pathogenesis

Peritoneal Inclusion Cyst in a pre-pubertal male

Introduction Peritoneal inclusion cyst (PIC) is a cyst lined with mesothelium and usually full of fluids in the pelvis and it is most usually seen in young women and rarely, they may occur in males.Case Presentation A 12 year old boy was referred with a two-day history of abdominal pain. Abdominal examination revealed lower abdominal tenderness. Laboratory tests were normal. Imaging by abdominal ultrasound and CT scan showed collection of fluid in the pelvis with some septations and lymphadenopathies. Shapeless cystic mass with thin membrane which was independent of abdominal organs was found during laparoscopy and extracted from pelvic cavity. Histopathologic examination established the diagnosis of peritoneal inclusion cyst.Conclusion peritoneal inclusion cyst should be in mind as differential diagnosis in a patient with intra-abdominal cystic fluid collection even in childhood and male gender

Oropharyngeal candidiasis in children with lymphohematopoietic malignancies in Mashhad, Iran

Background and Purpose: Over the past years, the role of fungi as a cause of nosocomial infections in hospitalized patients has been accentuated. Candida species constitute an important group of fungi causing diseases in immunocompromised patients. Oropharyngeal candidiasis continues to be a prevalent infection in immunodeficient patients. In this study, we aimed to determine the incidence of oropharyngeal candidiasis in children with lymphohematopoietic malignancies. Materials and Methods: In total, 102 patients with lymphohematopoietic malignancies and 50 healthy controls were examined in terms of Candida infections via direct sampling of the oropharyngeal cavity. Fresh smears were prepared with 10% potassium hydroxide and Gram staining was carried out. Subsequently, the obtained specimens were cultured on Sabouraud dextrose agar for further analysis. Results: The most common Candida species were Candida albicans (31%), other non-C. albicans species (14.7%), C. glabrata (6.8%), and C. krusei (0.98%) in the case group, while in the control group, other non-C. albicans species (10%) and C. albicans (8%) were the most common species. Conclusion: In the present study, Candida species were the most common fungal pathogens in pediatric cancer patients; therefore, efforts should be made to prevent fungemia and fungal pneumonia. Also, non-C. albicans species must be considered as a new risk factor for pediatric cancer patients