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Morais CG, Reis-Melo A, Oliveira J, Ribeiro A, Pinto-Carvalho I, Tavares M. Neuroimaging of central nervous system tuberculosis. Acta Neurol Taiwan 2023; 32(2):86-87. [PMID: 37198514] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
A 20-month-old female, not immunized with Bacillus Calmette-Guérin (BCG) vaccine, was admitted due to a four-day history of fever and cough. In the past three months, she presented respiratory infections, weight loss and enlarged cervical lymph nodes. On day two of admission, she displayed drowsiness and positive Romberg's sign; cerebrospinal fluid (CSF) workout revealed 107/ul cells, low glucose and high protein levels. Ceftriaxone and acyclovir were initiated, and she was transferred to our tertiary hospital. Brain magnetic resonance imaging showed punctiform focal areas of restricted diffusion in left capsular lenticular region suggestive of vasculitis secondary to infection. Tuberculin skin test and interferon-gamma release assay were positive. She started tuberculostatic therapy, but two days later she presented tonic-clonic seizures and impaired consciousness. Cerebral computed tomography (CT) revealed tetrahydrocephalus (Figure 1), needing external ventricular derivation. She had a slow clinical improvement, requiring several neurosurgical interventions and developing a syndrome of inappropriate antidiuretic secretion alternating with cerebral salt wasting. Positive results for Mycobacterium tuberculosis were obtained by CSF culture and by polymerase chain reaction in CSF, bronchoalveolar lavage and gastric aspirate specimens. Repeated brain CT showed a large-vessel vasculitis with basal meningeal enhancement, typical of central nervous system (CNS) tuberculosis (Figure 2). She completed one month of corticosteroids and maintained antituberculosis treatment. At two years of age, she has spastic paraparesis and no language skills. Portugal had 1836 cases of tuberculosis (17.8 per 100000) in 2016 and was considered a low-incidence country; consequently, BCG vaccination is not universal (1). We present a severe case of CNS tuberculosis with intracranial hypertension, vasculitis and hyponatremia, associated with poorer outcomes (2). A high index of suspicion allowed prompt start of antituberculosis treatment. Diagnosis was corroborated by microbiological positivity and a typical triad in neuroimaging (hydrocephalus, vasculitis and basal meningeal enhancement) (3), which we wish to emphasize.
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Affiliation(s)
| | - Ana Reis-Melo
- Pediatric Infectious Diseases and Immunodeficiency Unit, Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joana Oliveira
- Department of Neurosurgery, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Augusto Ribeiro
- Pediatric Intensive Care Unit, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Irene Pinto-Carvalho
- Department of Pediatrics, Centro Hospitalar e Universitário São João, Porto, Portugal
| | - Margarida Tavares
- Pediatric Infectious Diseases and Immunodeficiency Unit, Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
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Morais CG, Alves I, Coelho J, Vilares AT, Do Bom-Sucesso M. Multifocal Infantile Hepatic Hemangiomas Complicated by Consumptive Hypothyroidism: The Benefits of Early Diagnosis and Treatment. J Pediatr Hematol Oncol 2023; 45:e294-e297. [PMID: 35900056 DOI: 10.1097/mph.0000000000002509] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/02/2022] [Indexed: 11/26/2022]
Abstract
Infantile hepatic hemangiomas (IHH) account for 12% of all childhood hepatic tumors. Most IHH are diagnosed within the first 6 months of life and involute spontaneously; however, some require medical treatment. The present report describes a case of multifocal IHH associated with subcutaneous and lingual hemangiomas, complicated by consumptive hypothyroidism and successfully managed with oral propranolol and thyroid replacement therapy, without documented adverse effects. Consumptive hypothyroidism is a rare complication of IHH, but suggestive of multifocal/diffuse subtypes. The authors intend to reinforce the importance of early referral to a Vascular Anomalies Center and treatment with propranolol in selected patients.
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Rodrigues F, Marlow R, Gouveia C, Correia P, Brett A, Silva C, Gameiro I, Rua I, Dias J, Martins M, Diogo R, Lopes T, Hipólito E, Moreira D, Costa Alves M, Prata F, Labrusco M, Gomes S, Fernandes A, Andrade A, Granjo Morais C, João Virtuoso M, Manuel Zarcos M, Teresa Raposo A, Boon A, Finn A. Prospective study of loss of health-related quality adjusted life years in children and their families due to uncomplicated and hospitalised varicella. Vaccine 2023; 41:1182-1189. [PMID: 36522267 DOI: 10.1016/j.vaccine.2022.12.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2022] [Revised: 11/06/2022] [Accepted: 12/01/2022] [Indexed: 12/15/2022]
Abstract
INTRODUCTION AND AIMS Although usually benign, varicella can lead to serious complications and sometimes long-term sequelae. Vaccines are safe and effective but not yet included in immunisation programmes in many countries. We aimed to quantify the impact on health-related quality of life (HRQoL) in terms of quality-adjusted life years (QALY) in children with varicella and their families, key to assessing cost-utility in countries with low mortality due to this infection. METHODS Children with varicella in the community and admitted to hospitals in Portugal were included over 18 months from January 2019. Children's and carers' HRQoL losses were assessed prospectively using standard multi-attribute utility instruments for measuring HRQoL (EQ-5D and CHU9D), from presentation to recovery, allowing the calculation of QALYs. RESULTS Among 109 families with children with varicella recruited from attendees at a pediatric emergency service (community arm), the mean HRQoL loss/child was 2.0 days (95 % CI 1.9-2.2, n = 101) (mean 5.4 QALYs/1000 children (95 % CI 5.3-6.1) and 1.3 days/primary carer (95 % CI 1.2-1.6, n = 103) (mean 3.6 QALYs /1000 carers (95 % CI 3.4-4.4). Among 114 families with children admitted to hospital because of severe varicella or a complication (hospital arm), the mean HRQoL loss/child was 9.8 days (95 % CI 9.4-10.6, n = 114) (mean 26.8 QALYs /1000 children (95 % CI 25.8-29.0) and 8.5 days/primary carer (95 % CI 7.4-9.6, n = 114) (mean 23.4 QALYs/1000 carers (95 % CI 20.3-26.2). Mean QALY losses/1000 patients were particularly high for bone and joint infections [67.5 (95 % CI 43.9-97.6)]. Estimates for children's QALYs lost using the CHU9D tool were well correlated with those obtained using EQ-5D, but substantially lower. CONCLUSIONS The impact of varicella on HRQoL is substantial. We report the first measurements of QALYs lost in hospitalised children and in the families of children both in the community and admitted to hospital, providing important information to guide vaccination policy recommendations.
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Affiliation(s)
- Fernanda Rodrigues
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal.
| | - Robin Marlow
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, BS2 8AE, UK
| | - Catarina Gouveia
- Hospital D. Estefânia, Centro Hospitalar Lisboa Central, Rua Jacinta Marto, 1150-191 Lisboa, Portugal
| | - Paula Correia
- Hospital Prof. Doutor Fernando Fonseca, IC 19, 2720-276 Amadora, Portugal
| | - Ana Brett
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal; Faculdade de Medicina, Universidade de Coimbra, Azinhaga de Santa Comba, 3000-548 Coimbra, Portugal
| | - Catarina Silva
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Inês Gameiro
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Inês Rua
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - João Dias
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Marta Martins
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Rui Diogo
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Teresa Lopes
- Hospital Pediátrico, Centro Hospitalar e Universitário de Coimbra, Av. Afonso Romão, 3000-602 Coimbra, Portugal
| | - Elsa Hipólito
- Hospital Infante D. Pedro, Av. Dr. Artur Ravara, 3810-164 Aveiro, Portugal
| | - Diana Moreira
- Centro Hospitalar de Vila Nova de Gaia/Espinho (Unidade 2), Rua Dr. Francisco Sá Carneiro, 4400-129 Vila Nova de Gaia, Portugal
| | - Manuela Costa Alves
- Hospital de Braga, Rua das Comunidades Lusíadas 133, 4710-243 Braga, Portugal
| | - Filipa Prata
- Hospital Santa Maria, Centro Hospitalar Lisboa Norte, Av. Prof. Egas Moniz, 1649-028 Lisboa, Portugal
| | - Miguel Labrusco
- Hospital Beatriz Ângelo, Av. Carlos Teixeira, 2674-514 Loures, Portugal
| | - Susana Gomes
- Hospital do Espírito Santo, Largo Senhor da Pobreza, 7000-811 Évora, Portugal
| | - Alexandre Fernandes
- Centro Materno Infantil do Norte, Largo da Maternidade de Júlio Dinis, 4050-651 Porto, Portugal
| | - Alexandra Andrade
- Hospital Nélio Mendonça, Av. Luís de Camões 6180, 9000-177 Funchal, Portugal
| | - Catarina Granjo Morais
- Centro Hospitalar e Universitário de S. João, Alameda Prof. Hernâni Monteiro, 4200-319 Porto, Portugal
| | - Maria João Virtuoso
- Hospital de Faro, Centro Hospitalar e Universitário do Algarve, Rua Leão Penedo, 8000-386 Faro, Portugal
| | - Maria Manuel Zarcos
- Hospital de Santo André, Centro Hospitalar Leiria Pombal, Rua de Santo André, 2410-197 Leiria, Portugal
| | - Ana Teresa Raposo
- Hospital do Divino Espírito Santo, Av. D. Manuel I, 9500-370 Ponta Delgada, Portugal
| | - Adam Boon
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, BS2 8AE, UK
| | - Adam Finn
- Bristol Vaccine Centre, Schools of Population Health Sciences and of Cellular and Molecular Medicine, University of Bristol, BS2 8AE, UK
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Trindade TS, Morais CG, Maia A, Rodrigues M, Brito I. Demographic and clinical features of pediatric vasculitis: a single-center study. ARP Rheumatol 2023; 2:30-40. [PMID: 36739540] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Vasculitides are rare systemic conditions which may occur in childhood. This study aims to document demographic and clinical features of systemic vasculitides in a tertiary center, comparing our outcomes with previously published studies of other international centers. METHODS Patients presenting with systemic vasculitis before 18 years of age, admitted to a tertiary Portuguese center at diagnosis or during follow-up, from 2009 to 2020, were retrospectively included in this study. RESULTS In our study, we included 138 patients. The youngest patients at diagnosis were in the Kawasaki's disease (KD) group, with a median age at diagnosis of 2.26 years old (IQR 1.07-6.20), as opposed to the Behçet's syndrome (BS) group with a median age at diagnosis of 13.41 years old (IQR 10.19-16.75), which was significantly higher (p 90% in both IgA Vasculitis (IgAV) and KD. Gastrointestinal symptoms were common in all groups (15-50%), rarer in BS (17%). Arthritis and arthralgia were highly prevalent in IgAV (65%). The American Heart Association criteria of diagnosis for complete KD were met in 62% of cases. No significant difference was found in age distribution between complete and incomplete diagnosis (p=0.616). Mean duration of fever in KD was 9.6 ±2.1 days, which was higher than anticipated. Renal manifestations in IgAV (11%) and ophthalmic involvement in BS (22%) were lower than expected. There was a notable number of children reporting joint involvement in KD (27%). We also noticed a slightly higher prevalence of vascular events in BS (30%). CONCLUSIONS Each specific vasculitis assessed had different key symptoms, but there are several complaints and signs shown by our patients, some of them overlapping between vasculitides and others very atypical, such as recurrent epididymitis in BS due to microvasculitis. We can state that most of our findings are in concordance with current literature, with some notable exceptions. Pediatric multicentric population-based studies are warranted to increase research and design clinical trials concerning this field of knowledge.
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Affiliation(s)
- Tiago Santos Trindade
- Faculty of Medicine of the University of Porto, Centro Hospitalar e Universitário de São João
| | | | - Ana Maia
- Pediatrics Department, UAG-MC, Centro Hospitalar e Universitário de São João
| | - Mariana Rodrigues
- Unidade de Reumatologia Pediátrica e Jovem Adulto, Centro Hospitalar e Universitário de São João
| | - Iva Brito
- Unidade de Reumatologia Pediátrica e Jovem Adulto, Centro Hospitalar e Universitário de São João
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Morais CG, Quental R, Lourenço L, Guardiano M, Silva C, Leão M. Detection of a de novo heterozygous ANK2 variant in a child with autism spectrum disorder and epilepsy: a case report. Egypt J Med Hum Genet 2023. [DOI: 10.1186/s43042-023-00389-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
Background
The pathogenesis of autism spectrum disorder (ASD) is not fully clarified. Next-generation sequencing technologies have greatly enhanced the identification of new genes associated with ASD. Variants in ANK2 gene are known to correlate with a broad spectrum of clinical cardiac phenotypes, but, more recently, it has also been pointed out as a candidate gene for the etiology of ASD.
Case presentation
We report the case of a female patient with ASD and epilepsy in whom clinical exome sequencing was performed for etiological enlightenment. A heterozygous variant of uncertain significance was identified in the ANK2 gene: c.3412C > T p.(Arg1138Ter). The child was submitted to a formal cardiac evaluation, ruling out cardiovascular abnormalities. The genetic variant was searched in her parents and was negative in both, suggesting a de novo variant, which favors its pathogenicity.
Conclusions
We recognize the challenge of assessing variant pathogenicity in candidate genes for ASD, and ANK2 gene is currently not associated with neurodevelopmental disorders in the Online Mendelian Inheritance in Man database. Nonetheless, our case can be added to other published reports of de novo ANK2 variants in children with ASD and neurological phenotypes (including seizures), some without cardiac impairment. Hopefully, this study provides a more detailed phenotypical description that is often lacking, and it may contribute to a better understanding of the association between ANK2 and ASD.
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Morais CG, Gomes S, Fragoso AC, Coelho J, Jardim J, Barreira JL, Pinto-Carvalho I, Pinto H. Neonatal Urinary Tract Infection and Renal Nodular Lesion: A Rare Case of Xanthogranulomatous Pyelonephritis. J Investig Med High Impact Case Rep 2022; 10:23247096211066295. [PMID: 35038892 PMCID: PMC8771740 DOI: 10.1177/23247096211066295] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Xanthogranulomatous pyelonephritis (XPN) is an uncommon variant of chronic pyelonephritis with a poorly understood pathogenesis and a challenging diagnosis. It is rare in pediatric patients, particularly in the neonatal period. We report the case of an 18-day-old female neonate admitted to the emergency room due to macroscopic hematuria and poor feeding. Urinalysis revealed leukocyturia and she was initially admitted under the clinical suspicion of acute pyelonephritis. Renal ultrasound and magnetic resonance imaging (MRI) revealed a progressive nodular lesion in the middle third of the left kidney. Given the suspicion of renal abscess or neoplasm, the patient was transferred to our tertiary hospital. Urinary catecholamines and tumor markers had normal values. Percutaneous kidney biopsy confirmed XPN. Posterior computed tomography scan excluded extension to neighboring structures. A conservative management with systemic antibiotic therapy was decided. She completed 7 weeks of systemic antibiotic therapy (ampicillin and cefotaxime) with progressive reduction of lesion size and posterior calcification. Follow-up at 3 years was uneventful. The lipid profile and study of neutrophil function were normal. Voiding cystourethrography excluded vesicoureteral reflux. The authors intend to highlight the importance of a high index of suspicion of XPN to allow preoperative diagnosis. Histopathological assessment is mandatory to confirm XPN and exclude other entities mimicked by focal and unilateral progressive disease. There are only a few published cases of optimal clinical evolution solely with broad-spectrum antibiotics; however, this may allow a beneficial nephron-sparing approach in selected patients.
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Affiliation(s)
| | - Sara Gomes
- Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Ana Catarina Fragoso
- Department of Pediatric Surgery, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Janine Coelho
- Unit of Pediatric Hematology-Oncology, Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Joana Jardim
- Unit of Pediatric Nephrology, Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - João Luís Barreira
- Unit of Pediatric Nephrology, Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Irene Pinto-Carvalho
- Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
| | - Helena Pinto
- Unit of Pediatric Nephrology, Department of Pediatrics, Centro Hospitalar Universitário São João, Porto, Portugal
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Varela Branco S, Santos Vieira B, Granjo Morais C, Saraiva S, Pontes M. Neonatal Rash. J Pediatr 2021; 235:296-297. [PMID: 33887331 DOI: 10.1016/j.jpeds.2021.04.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 04/08/2021] [Accepted: 04/12/2021] [Indexed: 11/29/2022]
Affiliation(s)
- Sofia Varela Branco
- Departments of Pediatrics and Neonatology, Centro Hospitalar Póvoa de Varzim/Vila do Conde
| | - Beatriz Santos Vieira
- Departments of Pediatrics and Neonatology, Centro Hospitalar Póvoa de Varzim/Vila do Conde
| | - Catarina Granjo Morais
- Departments of Pediatrics and Neonatology, Centro Materno Pediátrico - Centro Hospitalar Universitário de São João
| | - Sílvia Saraiva
- Department of Neonatology, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Porto, Portugal
| | - Margarida Pontes
- Department of Neonatology, Centro Hospitalar Póvoa de Varzim/Vila do Conde, Porto, Portugal
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