Group A Streptococcal Pericarditis in a Four-Month-Old Infant : Case report

Purulent pericarditis is uncommon among paediatric patients and cases caused by group A Streptococcus (GAS) are even rarer. We report a four-month-old female infant who was referred to the Royal Hospital, Muscat, Oman, in 2015 with pericardial effusion and cardiac tamponade. She had initially presented to a secondary hospital with a two-week history of fever, a runny nose and shortness of breath. Blood and pericardial fluid cultures confirmed GAS isolates. The infant was treated with a two-week course of antibiotics and made a complete recovery with no echocardiographical evidence of pericardial effusion at a two-month follow-up. To the best of the authors’ knowledge, this case constitutes the youngest infant to present with GAS pericarditis. As invasive GAS infections can present in infancy, early recognition and treatment is required

Troubleshooting During Temporary Epicardial Lead Implantation in a Child with an Erosive Twiddler’s Syndrome and Multiple Sternotomies: A case report

Temporary epicardial cardiac pacing in patients with bradyarrhythmias may be used as a bridge to implantation of a permanent pacemaker. The temporary epicardial lead placement may sometimes necessitate a sternotomy that may pose a challenge in patients who have had multiple earlier sternotomies. The difficulty in accessing the epicardium for urgent implantation of temporary epicardial pacing leads depends on the extent of adhesions in such patients. We report an 8-year-8-month-old girl with a pacemaker with an extruded pulse generator and difficult myocardial access due to 5 prior transsternal procedures. The child presented to a tertiary care hospital in Muscat, Oman, in 2021. A trouble-shooting technique was adopted to achieve temporary epicardial pacing to provide time for a course of antibiotic therapy administration. A permanent transvenous pulse generator system was implanted after 7 days of temporary pacing. Keywords: Heart Block; Artificial Pacemaker; Implanted Electrodes; Case Report; Oman