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Kingma SDK, Neven J, Bael A, Meuwissen MEC, van den Akker M. Imerslund-Gräsbeck syndrome: a comprehensive review of reported cases. Orphanet J Rare Dis 2023; 18:291. [PMID: 37710296 PMCID: PMC10500774 DOI: 10.1186/s13023-023-02889-x] [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] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2023] [Accepted: 08/25/2023] [Indexed: 09/16/2023] Open
Abstract
Imerslund-Gräsbeck syndrome (IGS) is a rare autosomal recessive disorder characterized by vitamin B12 malabsorption. Most patients present with non-specific symptoms attributed to vitamin B12 deficiency, and proteinuria. Patients may if untreated, develop severe neurocognitive manifestations. If recognized and treated with sufficient doses of vitamin B12, patients recover completely. We provide, for the first time, an overview of all previously reported cases of IGS. In addition, we provide a complete review of IGS and describe two new patients.
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Affiliation(s)
- Sandra D K Kingma
- Centre for Metabolic Diseases, University Hospital Antwerp, University of Antwerp, Drie Eikenstraat 655, Edegem, Antwerp, 2650, Belgium
- Department of Pediatrics, University Hospital Antwerp, University of Antwerp, Drie Eikenstraat 655, Edegem, 2650, Belgium
- Faculty of medicine and health sciences, University of Antwerp, Antwerp, Belgium
| | - Julie Neven
- Department of Pediatrics, University Hospital Antwerp, University of Antwerp, Drie Eikenstraat 655, Edegem, 2650, Belgium
| | - An Bael
- Faculty of medicine and health sciences, University of Antwerp, Antwerp, Belgium
- Department of Pediatric Nephrology, ZNA Queen Paola Children's Hospital, Lindendreef 1, Antwerp, 2020, Belgium
| | - Marije E C Meuwissen
- Center of Medical Genetics, University Hospital Antwerp, Drie Eikenstraat 655, Edegem, 2650, Belgium
| | - Machiel van den Akker
- Department of Pediatrics, University Hospital Antwerp, University of Antwerp, Drie Eikenstraat 655, Edegem, 2650, Belgium.
- Faculty of medicine and health sciences, University of Antwerp, Antwerp, Belgium.
- Department of Pediatrics, ZNA Queen Paola Children's Hospital, Lindendreef 1, Antwerp, 2020, Belgium.
- Pediatric Hematology and Oncology, Department of Pediatrics, University Hospital Antwerp, Drie Eikenstraat 655, Edegem, Antwerp, 2650, Belgium.
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2
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van Heerden J, van den Akker M, Verlooy J, Van Roy N, Laureys G, Norga K. Dilemmas in the Management of an Infant with Neuroblastoma Metastasized to the Muscles. Case Rep Oncol 2023; 16:558-567. [PMID: 37900821 PMCID: PMC10601722 DOI: 10.1159/000531433] [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] [Received: 04/18/2023] [Accepted: 06/01/2023] [Indexed: 10/31/2023] Open
Abstract
The risk stratification of infants with metastatic neuroblastoma (NB) has evolved over time from stage 4/M or IVs/4S/MS/Ms according to various staging systems. Despite these developments for some genetic aberrations, the prognostic value and the impact of soft tissue metastases in infants are not fully understood, nor well described in the different classification systems, hampering the definitions to uniformly treat patients and predict prognosis. A literature review on staging of infants with M/MS disease was performed at the occasion of the diagnosis of NB in an 8-month-old boy who presented with atypical metastatic sites in soft tissue and an aberrant tumor biology. The definitions of stage 4/4S/4s/M/MS/Ms were evaluated and compared to enable tumor risk stratification and inform management. International NB groups use different criteria for defining stage of infants with metastasized NB, resulting in differences in management. Limited literature is available on soft tissue metastases, especially muscular metastases, and is poorly incorporated into management guidelines mainly due to the lack of data. The uncertain prognosis of rare genetic aberrancies may add to the difficulties in treatment decisions. In some rare cases of NB in infants, the international treatment classification is not sufficient for staging and treatment decisions. Based on tumor progression, biology of unknown significance and a lack of evidence to classify a child under 12 months with NB and multiple muscular metastases, the patient was treated as stage 4/M and intermediate-risk protocols with a favorable outcome.
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Affiliation(s)
- Jaques van Heerden
- Department of Pediatric Haematology and Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Machiel van den Akker
- Department of Pediatric Haematology and Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Joris Verlooy
- Department of Pediatric Haematology and Oncology, Antwerp University Hospital, Antwerp, Belgium
| | - Nadine Van Roy
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Center for Medical Genetics, Ghent University Hospital, Ghent, Belgium
| | - Geneviève Laureys
- Cancer Research Institute Ghent (CRIG), Ghent University, Ghent, Belgium
- Department of Pediatric Haematology, Oncology and Stem cell transplantation, Ghent University Hospital, Ghent, Belgium
| | - Koen Norga
- Department of Pediatric Haematology and Oncology, Antwerp University Hospital, Antwerp, Belgium
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3
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Jonckers B, Michielsen T, Severijns N, Elst H, Simoens F, Norga K, van den Akker M, van Heerden J, Verlooy J. Together Against Leukemia-the Strength of a Small Community. J Patient Exp 2021; 8:23743735211049675. [PMID: 34692994 PMCID: PMC8532204 DOI: 10.1177/23743735211049675] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Affiliation(s)
| | - Toke Michielsen
- Department of Psychology, Antwerp University Hospital, Antwerp, Belgium
| | - Nina Severijns
- Department of Psychology, Antwerp University Hospital, Antwerp, Belgium
| | - Heidi Elst
- UZA Hospital School, Urban Education, Antwerp, Belgium
| | | | - Koen Norga
- Paediatric Haematology and Oncology, Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Machiel van den Akker
- Paediatric Haematology and Oncology, Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Jaques van Heerden
- Paediatric Haematology and Oncology, Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium
| | - Joris Verlooy
- Paediatric Haematology and Oncology, Department of Paediatrics, Antwerp University Hospital, Antwerp, Belgium
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4
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van den Akker M, Chielens L, Lopes L, van Heerden J, Zaqout M, van der Werf Ten Bosch J. Thrombocytopenia in severe iron deficiency anemia in children. Health Sci Rep 2021; 4:e351. [PMID: 34557594 PMCID: PMC8448394 DOI: 10.1002/hsr2.351] [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] [Received: 01/30/2021] [Revised: 06/26/2021] [Accepted: 07/22/2021] [Indexed: 11/05/2022] Open
Abstract
AIM Iron deficiency anemia (IDA) is common in the pediatric population and often accompanied by mild thrombocytosis, but rarely profound thrombocytopenia is seen. We describe the data of children with IDA and thrombocytopenia in two centers and discuss the published data in the literature. METHODS In this retrospective case series, the medical records of patients under the age of 19 years old diagnosed with IDA in two tertiary medical centers over the last 10 years, were reviewed. The data were collected and compared to the data published in the medical literature. RESULTS All the patients presented with severe IDA and thrombocytopenia improved with iron treatment. Although none of the patients had signs of major bleeding, the thrombocytopenia could mostly be classified as severe (platelet count <50×10E9/L). Due to the severity of the anemia, in about half of the cases, a red blood cell transfusion was given. The peak of the platelet count was seen in the first month after the start of iron treatment. In eight cases of children with IDA, the thrombocytopenia appeared after the supplementation of iron was started. CONCLUSION Clinically stable children with severe IDA and thrombocytopenia, where other causes are very unlikely, warrant an empiric monotherapy with iron to prevent unnecessary investigations and treatments.
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Affiliation(s)
- Machiel van den Akker
- Department of PediatricsZNA Queen Paola Children's HospitalAntwerpBelgium
- Pediatric Hematology/Oncology Unit, Queen Mathilde Mother and Child CenterAntwerp University HospitalEdegemBelgium
- Department of Pediatric Hematology OncologyUZ BrusselJetteBelgium
| | - Laura Chielens
- Faculty of Medicine and Health SciencesUniversity of BrusselsJetteBelgium
| | - Lisa Lopes
- Faculty of Medicine and Health SciencesUniversity of AntwerpAntwerpBelgium
| | - Jaques van Heerden
- Pediatric Hematology/Oncology Unit, Queen Mathilde Mother and Child CenterAntwerp University HospitalEdegemBelgium
| | - Mahmoud Zaqout
- Department of PediatricsZNA Queen Paola Children's HospitalAntwerpBelgium
- Pediatric Cardiology Unit, Queen Mathilde Mother and Child CenterAntwerp University HospitalEdegemBelgium
| | - Jutte van der Werf Ten Bosch
- Department of PediatricsZNA Queen Paola Children's HospitalAntwerpBelgium
- Department of Pediatric Hematology OncologyUZ BrusselJetteBelgium
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5
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Yakubov R, Ayman A, Klein Kremer A, Bael A, van den Akker M. Unusual presentation of a five-month-old boy with NaPi2a homozygous mutation without hyperphosphaturia: Case report and review of the literature. Clin Case Rep 2021; 9:e04740. [PMID: 34532044 PMCID: PMC8435227 DOI: 10.1002/ccr3.4740] [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] [Received: 03/07/2021] [Revised: 07/15/2021] [Accepted: 08/09/2021] [Indexed: 11/10/2022] Open
Abstract
Deletions of the NaPi2a gene and mutations in the SLC34A gene should be considered in patients with atypical presentation, without phosphaturia, with mild hypo to normal phosphatemia, and nephrocalcinosis.
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Affiliation(s)
- Renata Yakubov
- Department of PediatricsHillel Yaffe Medical CenterHaderaIsrael
- Nephrology UnitHillel Yaffe Medical CenterHaderaIsrael
| | - Asaly Ayman
- Department of PediatricsHillel Yaffe Medical CenterHaderaIsrael
| | | | - An Bael
- Department of PediatricsZNA Queen Paola Children’s HospitalAntwerpBelgium
- Pediatric NephrologyZNA Queen Paola Children’s HospitalAntwerpBelgium
- Faculty of MedicineUniversity of AntwerpAntwerpBelgium
| | - Machiel van den Akker
- Department of PediatricsZNA Queen Paola Children’s HospitalAntwerpBelgium
- Faculty of MedicineUniversity of AntwerpAntwerpBelgium
- Department of Pediatric Hematology OncologyUZ BrusselBrusselsBelgium
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6
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Bonouvrie K, van der Werff Ten Bosch J, van den Akker M. Klinefelter syndrome and germ cell tumors: review of the literature. Int J Pediatr Endocrinol 2020; 2020:18. [PMID: 33005196 PMCID: PMC7526209 DOI: 10.1186/s13633-020-00088-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/22/2020] [Accepted: 08/27/2020] [Indexed: 11/10/2022]
Abstract
Objective The most common presentation of Klinefelter syndrome (KS) is infertility and features of hypogonadism. Currently no consensus exists on the risk of malignancy in this syndrome. Several case reports show an incidence of extragonadal germ cells tumors (eGCT) of 1.5 per 1000 KS patients (OR 50 against healthy population). Malignant germ cell tumors are rare in children. They account for 3% of all children cancers. Young patients with a germ cell tumor are not routinely tested for Klinefelter syndrome. This can therefore result in underdiagnosing. Literature data suggest a correlation between eGCT and KS. To the best of our knowledge there is no precise description of the primary locations of germ cell tumors in KS patients. The purpose of this study is to evaluate age groups and primary locations of extragonadal germ cell tumors in Klinefelter patients. With this data we investigate whether it is necessary to perform a cytogenetic analysis for KS in every eGCT patient. Study design This study is based on case report publications in PubMed/Medline published until march 2020 that described "Klinefelter Syndrome (MeSH) AND/OR extragonadal germ cell tumors". Publications were included when patients age, location and histology of the germ cell tumor was known. Two double blinded reviewers selected the studies.Results: 141 KS patients with eGCTs were identified. Mean age at presentation was 17.3 years (StDev + - 10.2). In contrast to the extragonadal germ cell tumors in adults, most eGCT in children were mediastinal or in the central nervous system (respectively 90/141; 64% and 23/141; 16% of all tumors). Distribution of histologic subtypes showed that the largest fraction represented a teratoma, mixed-type-non-seminomateus GCT and germinoma, respectively 34/141; 24%, 26/141; 18% and 20/141; 14% of all tumors. Conclusion These data suggest a correlation between primary extragonadal germ cell tumors and Klinefelter syndrome. There appears to be an indication for screening on KS in young patients with an eGCT in the mediastinum. A low threshold for radiologic examinations should be considered to discover eGCT. We emphasize the need for genetic analysis in all cases of a male with a mediastinal germ cell tumor for the underdiagnosed Klinefelter syndrome.
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Affiliation(s)
- Kimberley Bonouvrie
- Department of Pediatrics, Maxima Medisch Centrum, Veldhoven, The Netherlands.,Department of Pediatrics, ZNA Queen Paola Children's Hospital, Lindendreef 1, 2020 Antwerp, Belgium
| | - Jutte van der Werff Ten Bosch
- Department of Pediatrics, ZNA Queen Paola Children's Hospital, Lindendreef 1, 2020 Antwerp, Belgium.,Department of Pediatric Hematology and Oncology, University Hospital Brussel, Brussels, Belgium
| | - Machiel van den Akker
- Department of Pediatrics, ZNA Queen Paola Children's Hospital, Lindendreef 1, 2020 Antwerp, Belgium.,Department of Pediatric Hematology and Oncology, University Hospital Brussel, Brussels, Belgium
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7
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Yakubov R, Ayman A, Kremer AK, van den Akker M. One-month-old girl presenting with pseudohypoaldosteronism leading to the diagnosis of CDK13-related disorder: a case report and review of the literature. J Med Case Rep 2019; 13:386. [PMID: 31883531 PMCID: PMC6935476 DOI: 10.1186/s13256-019-2319-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2019] [Accepted: 11/20/2019] [Indexed: 01/27/2023] Open
Abstract
BACKGROUND It is not uncommon that an infant with a disease of unknown etiology is presented to a physician. Facial dysmorphic features lead to a different diagnosis. It is a challenge to link the presentation to the newfound diagnosis. CASE PRESENTATION A 37-day-old Yemenite Jewish girl was presented to our institution with a clinical picture of pseudohypoaldosteronism due to abnormal facial features and a psychomotor developmental delay. Further investigation led to the diagnosis of CDK13-related disorder. According to the literature, CDK13 has a key role in the cell cycle, but no interference with the aldosterone signaling pathway or electrolyte balance was described. No mutations in the previously described gene NR3C2 (cytogenetic location 4q31.23), encoding the mineralocorticoid receptor, were found. Although the clinical presentation corresponded to pseudohypoaldosteronism type 1, we could not genetically confirm this. CONCLUSIONS Probably pseudohypoaldosteronism was a coincidental finding in this girl with a CDK13 mutation, but because only limited information is known about CDK13-related disorders, further investigation could be more informative to clarify this presentation.
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Affiliation(s)
- Renata Yakubov
- Department of Pediatrics, Nephrology Unit, Hillel Yaffe Medical Center, Ha-Shalom Street, 38100, Hadera, Israel.
| | - Asaly Ayman
- Department of Pediatrics, Nephrology Unit, Hillel Yaffe Medical Center, Ha-Shalom Street, 38100, Hadera, Israel
| | - Adi Klein Kremer
- Department of Pediatrics, Nephrology Unit, Hillel Yaffe Medical Center, Ha-Shalom Street, 38100, Hadera, Israel
| | - Machiel van den Akker
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium.,Department of Pediatric Hematology Oncology, UZ Brussel, Brussels, Belgium
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8
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Cauwenberghs L, Bruynseels P, Demeyere N, van den Akker M. Cerebral vasculitis associated with an Echovirus 6 meningoencephalitis-Case report and review of the literature. Clin Case Rep 2019; 7:268-271. [PMID: 30847187 PMCID: PMC6389484 DOI: 10.1002/ccr3.1963] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [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] [Received: 07/26/2018] [Revised: 11/11/2018] [Accepted: 11/20/2018] [Indexed: 12/03/2022] Open
Abstract
When a previously healthy child presents to the hospital with a stroke, generally a Varicella zoster virus vasculopathy seems most likely. However, other causes of a local cerebral vasculitis are possible and need to be explored.
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Affiliation(s)
- Laura Cauwenberghs
- Department of PediatricsZNA Queen Paola Children’s HospitalAntwerpBelgium
- Department of PediatricsAntwerp University HospitalAntwerpBelgium
| | | | | | - Machiel van den Akker
- Department of PediatricsZNA Queen Paola Children’s HospitalAntwerpBelgium
- Department of Pediatric of Hematology OncologyUZ BrusselBrusselsBelgium
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9
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van den Broek L, van der Werff-Ten Bosch J, Cortoos PJ, van Steijn S, van den Akker M. Severe neutropenia in a breastfed infant: a case report and discussion of the differential diagnosis. Int Med Case Rep J 2018; 11:333-337. [PMID: 30532602 PMCID: PMC6245346 DOI: 10.2147/imcrj.s173826] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [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: 11/23/2022] Open
Abstract
Neonatal neutropenia is regularly seen with variable etiology. We describe a breastfed infant with maternal medication use as a probable cause of neonatal neutropenia. An 8 days old exclusively breastfed female infant of Arab-Berber descent was referred to our hospital because of an infection of the umbilicus. Complete blood count showed a picture of severe isolated neutropenia. After initiating intravenous antibiotic treatment, the infection quickly resolved, but the isolated neutropenia persisted. Bone marrow aspiration indicated severe congenital neutropenia. The mother was known to have Crohn’s disease, treated with methylprednisolone and adalimumab up to 3 months before delivery, and latent tuberculosis, for which she used isoniazid postnatally. Breast-feeding was terminated and filgrastim was started, with an increase of the neutrophilic count. After several weeks, filgrastim could be terminated. Bone marrow and complete blood count were repeated and were completely normal. This case report describes a very young breastfed female infant with severe neutropenia, causing an infection, in which maternal adalimumab use could not be excluded as a possible cause. Maternal isoniazid use is highly unlikely.
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Affiliation(s)
| | | | | | - Susanne van Steijn
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium,
| | - Machiel van den Akker
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium, .,Department of Pediatric Hematology Oncology, UZ Brussel, Brussels, Belgium,
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10
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Mangodt TC, Joos R, Siozopoulou V, Cortoos PJ, Baeten H, Docx M, van den Akker M. Perinuclear antineutrophil cytoplasmic antibody-positive vasculitis, oligoarthritis, tendinitis, and myositis associated with isotretinoin in a 15-year-old boy: Case report and review of literature. Pediatr Dermatol 2018; 35:e173-e177. [PMID: 29644707 DOI: 10.1111/pde.13445] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
We present a patient in whom a combination of perinuclear antineutrophil cytoplasmic antibody-positive vasculitis, oligoarthritis, tendinitis, and myositis was considered to be associated with isotretinoin use. Discontinuation of the drug resulted in complete clinical and biochemical remission (normalization of perinuclear antineutrophil cytoplasmic antibody titer). Although we were unable to prove causality, no other underlying cause for the patient's course was found. We report this occurrence to bring it to the attention of physicians prescribing isotretinoin.
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Affiliation(s)
- Thomas C Mangodt
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Rik Joos
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium.,Department of Pediatric Rheumatology, University Hospital of Ghent, Ghent, Belgium
| | | | | | - Hans Baeten
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium.,Faculty of Medicine and Health Sciences, University of Antwerp, Antwerp, Belgium
| | - Martine Docx
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium.,Department of Chronic Pediatric Diseases and Nephrology, Queen Paola Children's Hospital, Antwerp, Belgium
| | - Machiel van den Akker
- Department of Pediatrics, Queen Paola Children's Hospital, Antwerp, Belgium.,Department of Pediatric Hematology and Oncology, University Hospital of Brussels, Brussels, Belgium
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11
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Kappers W, Stevens G, Bruynseels P, van den Akker M. Papular Purpuric Gloves and Socks Syndrome because of a Mycoplasma Infection. J Pediatr 2018; 194:258-258.e2. [PMID: 29217102 DOI: 10.1016/j.jpeds.2017.10.050] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/07/2017] [Revised: 10/22/2017] [Accepted: 10/24/2017] [Indexed: 01/02/2023]
Affiliation(s)
- Willemijn Kappers
- Department of Pediatrics Queen Paola Children's Hospital Antwerp, Belgium
| | - Greet Stevens
- Department of Pediatrics Queen Paola Children's Hospital Antwerp, Belgium
| | | | - Machiel van den Akker
- Department of Pediatrics Queen Paola Children's Hospital Antwerp, Belgium; Department of Pediatric Hematology Oncology UZ Brussel Brussels, Belgium
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12
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Stevens T, van der Werff Ten Bosch J, De Rademaeker M, Van Den Bogaert A, van den Akker M. Risk of malignancy in 22q11.2 deletion syndrome. Clin Case Rep 2017; 5:486-490. [PMID: 28396774 PMCID: PMC5378830 DOI: 10.1002/ccr3.880] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [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] [Received: 07/10/2016] [Revised: 01/25/2017] [Accepted: 02/02/2017] [Indexed: 11/06/2022] Open
Abstract
22q11.2DS is a significant health problem because of its fairly high incidence. It is relevant to be vigilant regarding the diagnosis of cancer amongst 22q11.2 patients as there might be an increased risk, especially amongst patients with the 22q11.2 distal deletion syndrome.
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Affiliation(s)
| | | | - Marjan De Rademaeker
- Centre for Medical Genetics, Reproduction and Genetics Reproduction Genetics and Regenerative Medicine UZ Brussel Brussels Belgium
| | - Ann Van Den Bogaert
- Centre for Medical Genetics, Reproduction and Genetics Reproduction Genetics and Regenerative Medicine UZ Brussel Brussels Belgium
| | - Machiel van den Akker
- Department of Pediatric Hematology Oncology UZ Brussel Brussels Belgium; Department of Pediatrics Queen Paola Children's Hospital Antwerp Belgium
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13
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Leen I, Bruynseels P, Mukadi BK, van Oort M, van den Akker M. A 13-year old girl with pancytopenia at the presentation of a Borrelia hispanica infection: a case report and review of the literature. J Med Case Rep 2017; 11:51. [PMID: 28238286 PMCID: PMC5327536 DOI: 10.1186/s13256-017-1225-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [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] [Received: 07/19/2016] [Accepted: 01/26/2017] [Indexed: 11/23/2022] Open
Abstract
Background It is not uncommon that a child with a febrile illness of unknown etiology is admitted to the hospital. When the complete blood count reveals a pancytopenia, the diagnostic process can be a real challenge. Case presentation A 13-year girl of Arab-Berber descent presented with abdominal pain and fever after a holiday in northwestern Morocco. A complete blood count revealed a pancytopenia and blood smear test results revealed spirochetes. Borrelia hispanica was identified by sequencing the 16S ribosomal ribonucleic acid gene. Our patient was treated with tetracyclines and during this treatment we saw full clinical and hematological recovery. Conclusions Borrelia hispanica is a known cause of tick-borne relapsing fever and is transmitted to humans through the bite of soft ticks of the genus Ornithodoros (Alectorobius). Although the link between tick-borne relapsing fever and thrombocytopenia has been documented, there are only a few case reports of tick-borne relapsing fever presenting with pancytopenia. To the best of our knowledge, there is no previous report of Borrelia hispanica presenting with pancytopenia.
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Affiliation(s)
- Irmin Leen
- Department of Pediatrics, Queen Paola Children's Hospital, Lindendreef 1, 2020, Antwerp, Belgium.,Department of Emergency Medicine, ZNA Middelheim, Antwerp, Belgium
| | | | - Benoît Kabamba Mukadi
- Department of Clinical Microbiology, Cliniques Universitaires UCL St-Luc, Brussels, Belgium
| | - Mark van Oort
- Department of Pediatrics, Queen Paola Children's Hospital, Lindendreef 1, 2020, Antwerp, Belgium
| | - Machiel van den Akker
- Department of Pediatrics, Queen Paola Children's Hospital, Lindendreef 1, 2020, Antwerp, Belgium. .,Department of Pediatric Hematology Oncology, UZ Brussel, Brussels, Belgium.
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14
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van der Werff ten Bosch J, van den Akker M. Genetic predisposition and hematopoietic malignancies in children: Primary immunodeficiency. Eur J Med Genet 2016; 59:647-653. [DOI: 10.1016/j.ejmg.2016.03.001] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2015] [Revised: 02/18/2016] [Accepted: 03/08/2016] [Indexed: 01/24/2023]
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15
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van den Broek L, Heylen E, van den Akker M. Glucose-6-phosphate dehydrogenase deficiency: not exclusively in males. Clin Case Rep 2016; 4:1135-1137. [PMID: 27980749 PMCID: PMC5134135 DOI: 10.1002/ccr3.714] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [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] [Received: 01/23/2016] [Revised: 07/28/2016] [Accepted: 09/18/2016] [Indexed: 11/30/2022] Open
Abstract
Glucose‐6‐phosphate (G6PD) deficiency is the most common human enzyme defect, often presenting with neonatal jaundice and/or acute hemolytic anemia, triggered by oxidizing agents. G6PD deficiency is an X‐linked, hereditary disease, mainly affecting men, but should also be considered in females with an oxidative hemolysis.
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Affiliation(s)
| | | | - Machiel van den Akker
- Department of Pediatrics Queen Paola Children's Hospital Antwerp Belgium; Department of Pediatric Hematology Oncology UZ Brussel Brussels Belgium
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Schaefers J, Vervloessem D, De Roover D, De Praeter M, van der Werff Ten Bosch J, van den Akker M. Soft tissue swelling in children: case report, differential diagnosis, and diagnostic delay. Clin Case Rep 2016; 4:643-6. [PMID: 27386119 PMCID: PMC4929796 DOI: 10.1002/ccr3.585] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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] [Received: 02/10/2016] [Revised: 04/13/2016] [Accepted: 04/30/2016] [Indexed: 12/27/2022] Open
Abstract
A general practitioner faces regularly soft tissue swelling in otherwise healthy children. Delay in diagnosis of soft tissue malignancies is often due to asymptomatic nature and the unfamiliarity with the age-dependent differential diagnosis. Hence, an accurate knowledge is important to prevent important delay in diagnosis of potential malignancies.
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Affiliation(s)
| | - Dirk Vervloessem
- Pediatric Surgery Queen Paola Children's Hospital Antwerp Belgium
| | | | | | | | - Machiel van den Akker
- Department of Pediatrics Queen Paola Children's Hospital Antwerp Belgium; Pediatric of Hematology Oncology UZ Brussel Brussels Belgium
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van den Akker M, Dror Y, Odame I. Transient erythroblastopenia of childhood is an underdiagnosed and self-limiting disease. Acta Paediatr 2014; 103:e288-94. [PMID: 24635829 DOI: 10.1111/apa.12634] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/09/2014] [Accepted: 03/12/2014] [Indexed: 11/30/2022]
Abstract
AIM Transient erythroblastopenia of childhood (TEC) is an uncommon, benign normocytic anaemia of unknown cause, characterised by reduced or absent mature erythroid precursors in otherwise normocellular bone marrow and a complete spontaneous recovery. We present epidemiological data on paediatric TEC cases in a single centre over 30 years and compare them with published data. METHODS In this retrospective study, epidemiological data on children diagnosed with TEC between 1978 and 2008 were collected and compared with published data. RESULTS A total of 36 children (median age 19 months, 56% male children) were diagnosed. At presentation, median haemoglobin was 44 g/L with absolute reticulocyte count 0 × 10(9) /L; seventeen (47%) patients were neutropenic and 23 (64%) had platelet counts of more than 400 × 10(9) /L. The majority (78%) presented from 1983 to 1997, and 78% of articles reviewing 10 or more TEC patients were published between 1983 and 1992. CONCLUSION Transient erythroblastopenia of childhood is now diagnosed less frequently in our institution than in the last two decades. Although the aetiology remains largely unknown, it is possible that changes in causative environmental factors contribute to making TEC a rare disease. Clinicians need to be aware of TEC in order to prevent unnecessary diagnostic and therapeutic measurements.
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Affiliation(s)
| | - Yigal Dror
- Division of Haematology/Oncology; Hospital for Sick Children; Toronto ON Canada
| | - Isaac Odame
- Division of Haematology/Oncology; Hospital for Sick Children; Toronto ON Canada
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Abstract
A 9-year-old boy with known Duchenne type muscular dystrophy (DMD) presented with signs of increased intracranial pressure. Radiological investigations revealed a lesion in the midline of the posterior fossa. Subtotal resection was performed. Pathology findings were consistent with the diagnosis of anaplastic medulloblastoma. The postoperative lumbar CSF was positive for malignant cells. Postoperatively, the patient showed severe neurological deterioration and lost his capacity to walk. He was treated with craniospinal radiation followed by nonintensive chemotherapy. At 30 months postsurgery, he was still in complete remission but had not recovered his walking ability. This is the second report of a malignant brain tumor in a boy with DMD. The possible link between the 2 conditions is discussed, as are ethical considerations regarding the management of medulloblastoma in children with DMD.
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Affiliation(s)
- Machiel van den Akker
- Division of Haematology/Oncology, Hospital for Sick Children, University of Toronto, Ontario, Canada.
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van den Akker M, Angelini P, Taylor G, Chami R, Gerstle JT, Gupta A. Malignant pancreatic tumors in children: a single-institution series. J Pediatr Surg 2012; 47:681-7. [PMID: 22498381 DOI: 10.1016/j.jpedsurg.2011.11.046] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2011] [Revised: 11/14/2011] [Accepted: 11/16/2011] [Indexed: 02/07/2023]
Abstract
BACKGROUND Pancreatic tumors in children represent a very rare entity. We reviewed the clinical and pathologic features of pediatric patients with pancreatic tumors at a single institution. METHODS We conducted a retrospective review of cases diagnosed at the Hospital for Sick Children between 1986 and 2010. RESULTS Twenty-seven patients were diagnosed during the study period: 18 with solid pseudopapillary neoplasm (SPN), 6 with pancreatic endocrine neoplasia, and 3 with other tumors. Of the 27 children, 3 had associated syndromes, in specific tuberous sclerosis, von Hippel-Lindau, and polycystic ovarian syndrome. The most common symptoms were pain and vomiting in SPN and hypoglycemia and seizures in insulinomas. Magnetic resonance imaging and computed tomographic scan were equally accurate in determining size and site of origin of the tumor, and both were better than ultrasound. All patients underwent surgery (distal pancreatectomy in 14 cases, Whipple procedure in 8, other procedures in 5), which represented the only treatment for all but 3 cases. Seventeen patients (94%) with SPN are alive (median follow-up, 32 months), 3 of whom had positive margins. Two patients died: 1 male with SPN with malignant transformation and 1 with fibrosarcoma. CONCLUSIONS We describe the largest single-institution study of pediatric pancreatic tumors. Females with SPN have an excellent outcome, even in presence of positive margins, suggesting that limited surgical resection may be appropriate for these patients.
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Affiliation(s)
- Machiel van den Akker
- Department of Hematology/Oncology, Queen Paola Children's Hospital, Antwerpen, Belgium
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van den Akker M, Zudekov V, Moser A, Kapelushnik J. An osseous lesion in a 10-year-old boy with Hodgkin's lymphoma: a case report. J Med Case Rep 2011; 5:511. [PMID: 21982527 PMCID: PMC3206865 DOI: 10.1186/1752-1947-5-511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2011] [Accepted: 10/08/2011] [Indexed: 11/10/2022] Open
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