ABSTRACT Haemoptysis is defined as the expectoration of blood or blood-tinged sputum originating from the lower respiratory tract. Massive haemoptysis, although rare, can often cause life-threatening asphyxia, respiratory failure, shock and, rarely, mortality. Pulmonary tuberculosis (PTB), although common, rarely presents with massive haemoptysis. This case report highlights an adolescent male who presented with life-threatening haemoptysis owing to PTB which was managed by successful pulmonary vascular embolisation. Abbreviations: AV: arteriovenous; BAE: bronchial artery embolisation; BPF: bronchopulmonary fistula; CHD: congenital heart disease; CT: computed tomography; ml: millilitre; mm: millimetre; TB: tuberculosis; U.S.A.: United States of America.

Placental chorio-angiomas are rare benign vascular tumours of the placenta which are usually small and clinically insignificant, but large lesions can cause serious fetal complications such as anaemia, hydrops fetalis and an adverse perinatal outcome. We report the case of a 29-year-old multigravida diagnosed at 28 weeks' gestation with a large placental chorioangioma accompanied by sonographic evidence of fetal anaemia and hydrops fetalis. Despite two intra-uterine transfusions which led to partial improvement, the hydrops persisted, necessitating a preterm caesarean delivery at 31 weeks. The newborn required prolonged neonatal intensive care for respiratory distress, hydrops, thrombocytopenia and bronchopulmonary dysplasia, but there was satisfactory growth and neurodevelopment at 12 months of age. This case highlights the importance of early diagnosis and timely, individualised fetal therapy in managing large chorio-angiomas, and underscores how coordinated care through public-private partnership in a resource-limited setting can support effective continuity of antenatal and neonatal management, leading to a favourable perinatal outcome.

Tuberculosis (TB) is one of the most common infectious diseases in India with paediatric TB accounting for approximately 6-7% of cases. Skeletal and soft tissue are rare sites for TB. Three cases seen in a western tertiary hospital in India aged between 1 and 11 years presented with a swelling on the anterior chest wall. None had any known TB contact. Imaging demonstrated the presence of collections and underlying bony as well as pulmonary/pleural involvement. All were positive for TB on histopathology. They were commenced on anti-TB therapy and there was significant improvement on follow-up. Hence, tuberculosis with intrathoracic extension must be borne in mind as a close differential diagnosis when evaluating anterior chest wall swelling as it is treatable, especially in endemic areas.

ABSTRACT Primary ciliary dyskinesia (PCD) is a rare genetic disorder characterised by defective ciliary motility, resulting in chronic pulmonary infections and bronchiectasis. An 8-year-old boy with recurrent pulmonary tuberculosis (PTB) and newly diagnosed PCD by whole exome sequencing (WES) is reported. He presented with a chronic cough, intermittent fever, night sweats and weight loss, 3 months after completing a 6-month first-line antituberculosis therapy (ATT) regimen for drug-sensitive PTB. High-resolution computerised tomography showed bronchiectatic changes and chronic suppurative lung disease. Broncho-alveolar lavage fluid was tested on Xpert MTB/Rif Ultra and detected rifampicin-sensitive Mycobacterium tuberculosis. In view of the bronchiectasis and chronic suppurative lung disease, WES was undertaken which identified a PCD variant of unknown significance. The Primary Ciliary Dyskinesia Rule (PICADAR) score was calculated to be 8. He was diagnosed with PCD and a relapse of drug-sensitive PTB, for which first-line ATT was resumed. In view of possible syndromic conditions such as PCD, this case highlights the need for clinical suspicion and genetic testing in paediatric patients with recurrent pulmonary TB and bronchiectasis.

ABSTRACT An 8-week-old infant girl with pertussis-induced respiratory distress, complicated by severe leucocytosis, pulmonary hypertension and respiratory failure is reported. She was treated with mechanical ventilation, exchange transfusion and other supportive measures. A single-volume exchange transfusion significantly reduced the elevated white blood cell count and stabilised her condition. This case underscores the potential role of exchange transfusion as a life-saving intervention in critical pertussis cases with severe leucocytosis.

ABSTRACT A 3-year-old boy with atypical skin lesions was diagnosed with syphilis, probably acquired through close daily contact with his grandparents. The case highlights the critical need for syphilis testing in children with non-specific skin findings, particularly when familial exposure is suspected. Physicians should prioritise thorough assessment, including detailed enquiry into the child’s medical history, feeding practices, lifestyle and potential exposure to infection. Prompt screening of close contacts including family members and carers is essential in order to identify infection sources and prevent further transmission. Abbreviations: ANA: Antinuclear antibody; ESR: Erythrocyte sedimentation rate; RPR: Rapid plasma reagin; TPPA: T. pallidum particle agglutination

ABSTRACT Mycoplasma pneumoniae is a common cause of community-acquired pneumonia (CAP) in children. While M. pneumoniae infection is typically mild and self-limiting, individuals of all ages may develop severe CAP or extrapulmonary manifestations such as M. pneumoniae-induced rash and mucositis (MIRM). Severe M. pneumoniae pneumonia with concurrent MIRM in an 8-year-old boy is reported. The clinical course was complicated by persistent fever, severe mucositis and bilateral multi-lobar pneumonia requiring advanced respiratory support. Initial antibiotic and supportive therapy yielded little improvement, but the introduction of corticosteroids resulted in marked clinical improvement of both the pneumonia and mucositis. This case emphasises that MIRM may indicate a more severe course of M. pneumoniae infection, and that early corticosteroid therapy could be beneficial in such cases. Abbreviations: CAP: community-acquired pneumonia; CRP: C-reactive protein; EM: erythema multiforme; HFNC: high-flow nasal cannula; MIRM: Mycoplasma pneumoniae-induced rash and mucositis; PCR: polymerase chain reaction; RIME: reactive infectious mucocutaneous eruption; SJS: Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis; MIRM: Mycoplasma pneumonia-induced

ABSTRACT Thalassaemia is the most common inherited haemoglobin disorder worldwide and a major health problem. Beta-thalassaemia major generally presents with a normal serum lipid profile, but there have been a few reports of its association with hypertriglyceridaemia, the exact pathogenesis of which remains unknown, and where early and regular blood transfusions ameliorate hypertriglyceridemia, thereby preventing its complications and the need for medical treatment of hypertriglyceridemia. This entity was seen in a 6-month-old infant girl who presented with severe anaemia, failure to thrive and organomegaly, and was incidentally found to have hypertriglyceridaemia. Hypertriglyceridaemia thalassaemia syndrome has rarely been described.

ABSTRACT Acute acalculous cholecystitis (AAC) is a rare but potentially serious disorder associated with Kawasaki disease (KD). Studies have demonstrated that patients presenting with severe abdominal symptoms owing to KD have increased resistance to intravenous immunoglobulin (IVIG) and a higher rate of coronary artery aneurysms. A 5-year-old boy was brought to the emergency department with fever, abdominal pain, vomiting and jaundice. He presented as ACC and was subsequently diagnosed with KD because the symptoms and signs he developed during admission were consistent with that. He was treated with IVIG and high-dose aspirin, and was discharged 7 days later with complete resolution of the symptoms. Abbreviations: AAC acute acalculous cholecystitis; ALT alanine transaminase; AST aspartate aminotransferase; CMV cytomegalovirus; CRP C-reactive protein; EBV Epstein—Barr virus; GGT gamma-glutamyl transferase; IVIG intravenous immunoglobulin; KD Kawasaki disease.

ABSTRACT Kawasaki disease is a common childhood vasculitis of unknown aetiology, with infectious triggers often proposed. The association of Kawasaki disease with Dengue is rare. It often poses a diagnostic challenge owing to the close overlap of clinical features and a lack of diagnostic tests for Kawasaki disease. Concominant Dengue fever and Kawasaki disease in a 7-month-old boy is reported, and the possible association between the two conditions is considered. He presented with an acute febrile illness and was diagnosed with Dengue fever based on positive serology. Despite standard management for Dengue, he remained febrile and developed features suggestive of incomplete Kawasaki disease. Echocardiogram demonstrated a small coronary artery aneurysm. There was a dramatic response to intravenous immunoglobulin and aspirin. Follow-up at 6 weeks showed complete resolution of the aneurysm without residual cardiac sequelae. Kawasaki disease should be considered in children with Dengue who have persistent fever or evolving clinical features. Prompt recognition and treatment are essential to prevent coronary artery complications. The rare co-existence of Dengue and Kawasaki disease raises the question of whether this is a mere association or a potential trigger, highlighting an area for future research.