Healthy Young Girl Research Articles

Post COVID-19 ischemic stroke in a 15-Year-old patient.

Coronavirus disease 2019 (COVID-19) has been reported in the literature to be associated with a higher risk of stroke in young individuals with no previous risk factors. We present here one such case of a 15-year-old girl with posterior circulation ischemic stroke resulting in dense right hemiplegia and cerebellar incoordination. The patient tested positive for COVID-19 infection without displaying any symptoms of active COVID-19 infection at the time of the stroke. An MRI brain scan showed acute infarcts in the pons and left cerebellar hemisphere, and a CT angiogram of the cerebrovascular system showed occluded left vertebral and basilar arteries.The most salient feature of this case is COVID-19 infection manifesting clinically as cerebrovascular thrombosis in an otherwise healthy young girl with no pre-existing comorbidities and no laboratory findings of coagulopathy except for mildly elevated D-dimer.

Severe acute necrotising Community Acquired Pneumonia with Pyopneumothorax due to Pseudomonas aeruginosa in a healthy young girl

Aim: We report this case to acknowledge the presence of multi drug resistant Pseudomonas aeruginosa in the community setting, which transpired in a young female, without any known comorbidity or exposure risk.
 Background: Pseudomonas aeruginosa is an extremely unusual pathogen in community acquired pneumonia (CAP), especially in previously healthy young adults. Immune status, underlying lung disease and possible exposures like hot tub use, should always be ruled out. There have been reports of bacterial aetiology being next common after Tuberculosis for Pyopneumothorax, but ours is the first case to report P.aeruginosa as a cause of CAP and pyopneumothorax in an absolutely healthy young adult.
 Case description: A young female, developed Pneumonia from the community setting which grew a nosocomial organism. Complications involved cavity formation and Pyopneumothorax, which required Intercostal Drainage (ICD) and extensive intravenous antibiotics. Immediate and appropriate management is life saving.
 Conclusion: CAP due to heinous organisms like Pseudomonas aeruginosa should be suspected in any patient who presents with a rapidly progressive course, even in the absence of risk factors and exposures. In cases of Pleural effusion or Pneumothorax or both, ICD drain should be inserted. Broad spectrum antibiotic coverage especially in hemodynamically unstable patients should be initiated immediately, followed by antibiotic stewardship protocols.
 Clinical significance: We would like to emphasize the importance of acquiring cultures from respiratory site, for early initiation/switching of appropriate antibiotics. Also Pseudomonas being an ominous organism yields a finer prognosis only when treated with appropriate anti-pseudomonal antibiotics.

Concurrent Central Retinal Artery and Vein Occlusion in a Pediatric Patient

Abstract Purpose: To describe a rare case of combined central retinal artery (CRAO) and vein occlusion (CRVO) in pediatric patient. Case report: We report a case of mixed right eye CRAO and CRVO in a healthy young girl. A nine- year-old child presented with right eye sudden loss of vision. Upon presentation vision was counting finger at 1 feet. Afferent pupillary defect was positive. Fundus examination revealed pre-retinal and retinal hemorrhages in all 4 quadrants with pale retina and cherry red spot. All blood test results were normal except elevated erythrocyte sedimentation rate and complement (C3, C4) level. Fluorescence angiogram revealed delayed arm to retina time, venous filling and large area of capillary fallout. Her right eye vision improved to 1/60 with intravenous steroids. Conclusion: Combined CRAO and CRVO is possible in a healthy children. Thorough investigations should be done to sought the cause and hence proper management applied

'Lachnoclostridium massiliosenegalense', a new bacterial species isolated from the human gut microbiota.

We report the main characteristics of ‘Lachnoclostridium massiliosenegalense’ strain mt23T (=CSUR P299 =DSM 102084), a new bacterial species isolated from the gut microbiota of a healthy young girl from Senegal.

"Lachnoclostridium touaregense," a new bacterial species isolated from the human gut microbiota.

We report the main characteristics of “Lachnoclostridium touaregense” strain Marseille-P2415T (= CSUR P2415 = DSM 102219), a new bacterial species isolated from the gut microbiota of a healthy young girl from Niger.

Congenital Bilateral Thenar Amyotrophy due to Carpal Tunnel Narrowing

Bilateral thenar musculature atrophy due to carpal tunnel syndrome is rarely documented in children. It is usually the result either of carpal bone malformation or of hereditary metabolic disorders. We report a case of a 5-year-old female patient presenting with thenar atrophy due to severe median neuropathy at the carpal tunnel of both hands. Using high-resolution ultrasonography, we detected a significant carpal tunnel deformation due to a narrowing at its inlet. Additional tests did not reveal structural alterations of carpal bones nor metabolic disorders. Surgery, which had been initially ruled out, was performed when the patient was 15 years old in view of progressive worsening (complex regional autonomic syndrome). Surgery improved symptoms and confirmed the above morphological findings. We present a case of both acute bilateral median neuropathy at carpus and bilateral symmetric deformation of carpal tunnel due to a narrowing of the entrance in a healthy young girl without other causative pathology. To our knowledge, such a case has not been described before.

Isolated asymptomatic short sternum in a healthy young girl.

Congenital sternal defects are rare deformities frequently associated with other anomalies of the chest wall and other organ systems. Although pectus excavatum, pectus carinatum, and cleft sternum can present as isolated deformity, in most cases they are associated with heart and inner organs anomalies and described as symptoms of syndromes like Marfan syndrome, Noonan syndrome, Poland anomaly, and Cantrell pentalogy. In contrast, the etiology of an isolated defect is not well understood. We observed a short sternum (dysmorphic manubrium, hypoplastic body, and complete absence of the xiphoid process) in a completely asymptomatic 13-year-old woman. A comprehensive instrumental exams panel was performed to exclude associated anomalies of the heart and of the other organ systems. The patient was completely asymptomatic and she did not need any medical or surgical treatment. To our knowledge, this is the first case of isolated short sternum reported in literature.

“Nocturnal Seizures” in Idiopathic Pulmonary Arterial Hypertension

The usual differential diagnoses of nocturnal events in children include parasomnias, nocturnal seizures, nocturnal reflux (Sandifer syndrome), hypnic jerks, periodic limb movements of sleep, and sleep disordered breathing. We report a previously healthy young girl who presented to the sleep clinic for evaluation of nocturnal events which were diagnosed as medically refractory nocturnal seizures. It was not until a syncopal event occurred in the daytime, which prompted referral for cardiac evaluation, the diagnosis of idiopathic pulmonary arterial hyper-tension (IPAH) was made. Sleep physicians should consider IPAH in the differential diagnosis of nocturnal events in children.

Multiseptate gallbladder as a cause of recurrent abdominal pain in a child

Dear Editor, The congenital malformations of the gallbladder are classified as anomalous forms, abnormal position, and absence. Multiseptate gallbladder is a quite rare condition, which was first described by Simon and Tandon in 1963 [1-3]. A 10-year-old female was admitted to the hospital with recurrent attacks of abdominal pain for about one year duration. There was no history of sickle cell disease or any other blood disorders. Physical examination revealed a healthy young girl with no other abnormalities. Laboratory tests showed leucocytosis and a slight increase in transaminases and total bilirubin. Other laboratory tests were normal. Abdominal ultrasound revealed a multiseptate gallbladder with normal wall thickness, which resulting in a multi-compartment feature (Figure 1). No calculi were present. There were no gallstones or dilatation of the intrahepatic and extrahepatic bile ducts. On the basis of ultrasound study, a diagnosis of multiseptate gallbladder was made. The patient was treated conservatively. After the first week of treatment, she had complete relief of abdominal pain and her laboratory test results returned to normal. Follow-up sonography was performed and no change was found in the sonographic signs. Multiseptate gallbladder is a quite rare condition, which commonly causes symptoms suggestive of cholecystitis. Most patients are female adults though it can occur in children and men. Previously reported multiseptate gallbladder cases have been characterised by the presence of multiple thin septa dividing the gallbladder lumen into various sized chambers, often with a honeycomb appearance. Recurrent abdominal pain in childhood due to gallbladder disease is often misinterpreted as intestinal and genitourinary pathologies. Cholelithiasis and cholecystitis are very rare before puberty. If it is present, it is mostly related to bacterial and parasitic infections, hemolytic conditions and chronic gastrointestinal diseases [3-6]. The mechanism of pain in these patients is not well known. The symptoms are probably due to increased intraluminal pressure of the gallbladder and the mechanical effect of septa impairing normal bile flow. Biliary calculi are usually absent in multiseptate gall-bladder while choledochal cysts have been associated [1, 2, 4, 5]. In conclusion, gallbladder abnormalities, although rare should always be considered in the differential diagnosis of children presenting with recurrent attacks of abdominal pain, and abdominal ultrasound should form part of their investigations.

A Rare Fungal Infiltration of Lungs in a Healthy Young Girl

Cunninghamella bertholletiae is an opportunistic fungal organism found in soil and is a rare cause of human disease. The few reported cases of C. bertholletiae have involved immune compromised hosts. We report a case of C. bertholletiae in an otherwise healthy patient presenting with persistent high-grade fever and pulmonary infiltration resistant to antibiotics. The organism is isolated through bronchoscopy and responded to broad spectrum antifungal. This is the first case of C. bertholletiae reported in the literature in an immune competent individual.

Idiopathic pediatric retinal artery occlusion

We report a case of branch retinal artery occlusion (BRAO) in a healthy young girl. An eight-year-old girl presented with sudden loss of vision in her left eye. She had a pale retina with macular edema consistent with extensive BRAO. A thorough workup was performed to determine any etiologic factor. All test results were within normal limits. Her visual acuity improved from finger counting to 20/40 over two weeks, on immediate treatment with intravenous steroids (methyl prednisolone). This case suggests that BRAO can occur in healthy children without any detectable systemic or ocular disorders and a dramatic improvement may be achieved with prompt treatment with intravenous steroids.

Smoking-Induced Acute Eosinophilic Pneumonia in a 15-year-old Girl: A Case Report

Acute eosinophilic pneumonia is a very rare disease that is characterized by acute febrile respiratory failure, diffuse bilateral infiltrates on chest X-ray, and eosinophilia in bronchoalveolar lavage fluid in the absence of infection. We present the case of a 15-year-old girl diagnosed with smoking-induced acute eosinophilic pneumonia. A previously healthy young girl with a 1-day history of fever presented with cough, dyspnea, and diffuse bilateral infiltrates on chest X-ray. She had started smoking only 3 weeks before presentation. She was diagnosed by bronchoalveolar lavage fluid tests and lung biopsy and dramatically improved after steroid treatment. We emphasize that acute eosinophilic pneumonia must be considered when acute pneumonia does not respond to broad-spectrum antibiotics. Effective treatment and prompt institution of therapy can obviate unnecessary morbidity and mortality.

Diagnosis and treatment of giant lateral abdominal wall haematoma after blunt trauma: a case report

Lateral abdominal wall haematoma after blunt trauma that require surgery is rare. They usually present with pain, bruising and swelling after trauma.We report a case of a fit and healthy young girl who developed a large lateral abdominal wall haematoma following blunt trauma. Initially the haematoma was managed conservatively, however in view of increasing size surgical removal was undertaken. Post operatively the patient developed a small seroma and which was subsequently drained under ultrasound guidance. A thorough review of the literature has identified there are various options of treatment for patients with lateral abdominal wall haematoma. We conclude that management of giant traumatic lateral abdominal wall haematoma can be challenging, some will eventually need surgical intervention.

Acute Respiratory Failure Secondary to Primary Spontaneous Pneumothorax

Primary spontaneous pneumothorax occasionally occurs in young healthy individuals. Most of the time, it is diagnosed before it progresses to acute respiratory failure. We present a healthy young girl who developed acute respiratory failure secondary to primary spontaneous pneumothorax. Prompt evaluation and management are essential because this entity can lead to fatal outcome if not diagnosed and treated immediately.

Lemierre syndrome in a previously healthy young girl

Lemierre syndrome in a previously healthy young girl

Recurrent isolated ptosis in presumed ophthalmoplegic migraine of childhood

Purpose To report a rare case of isolated, recurrent unilateral eyelid ptosis as the sole manifestation of ophthalmoplegic migraine in a healthy young girl. Design Single observational case report with review of the literature. Testing Serologic evaluation, electromyographic, nerve conduction and Tensilon testing, magnetic resonance and computerized tomographic imaging, and magnetic resonance angiography were performed. Main outcome measures Four-year descriptive history of recurrent eyelid ptosis. Results Between 1994 and 1998, seven discrete episodes of right upper eyelid ptosis without ophthalmoplegia or pupil abnormality occurred. On each occasion, spontaneous resolution occurred over a period of 6 to 10 weeks. Extensive clinical and laboratory evaluation, including testing for myasthenia gravis and magnetic resonance cerebral angiography, was unremarkable. Conclusions Recurrent isolated ptosis is a rare manifestation of presumed ophthalmoplegic migraine in childhood. As far as we are aware, this has not been previously reported.

Primary cutaneous mucormycosis in a healthy young girl: Report of a case caused by Mucor hiemalis Wehmer

We report an unusual case of primary cutaneous mucormycosis caused by Mucor hiemalis Wehmer that occurred in a healthy young girl after an insect bite. The patient had a slowly extending, indurated, erythematous, and scaling eruption on the right cheek. Histologic examination revealed granulomatous dermatitis and characteristic broad, nonseptate, pale-staining hyphae. This is the first report of an infection in a human being caused by Mucor hiemalis Wehmer. The infection was cured with intravenous amphotericin B.

Varicella and Perforation of the Stomach

Involvement of the gastrointestinal tract is rare in varicella. We report a previously healthy young girl with perforation of the stomach that appeared to be a complication of varicella. Varicella inclusion bodies were demonstrated at the site of gastric perforations. On surgery, an organoaxial volvulus of the stomach was demonstrated.

Varicella and Perforation of the Stomach

Involvement of the gastrointestinal tract is rare in varicella. We report a previously healthy young girl with perforation of the stomach that appeared to be a complication of varicella. Varicella inclusion bodies were demonstrated at the site of gastric perforations. On surgery, an organoaxial volvulus of the stomach was demonstrated.

Sudden unexpected death 12 years after “near-miss” sudden infant death syndrome in infancy

Sudden infant death syndrome (SIDS) is recognized as the largest single cause of death in infants between 1 week and 1 year of age in the U.S., accounting for the unexpected deaths of approximately 10,000 previously well infants annually. 1 Infants who survive episodes of respiratory or cardiorespiratory arrest have been described as having aborted, or “near-miss,” SIDS events, which are generally presumed to represent a variant of true SIDS. 2 Although “near-miss” occurrences may be repetitive, death rarely occurs in infancy. 2–3 However, the long-term significance of aborted SIDS events and the risk for subsequent catastrophe in these children is not known. The following case of an apparently healthy young girl with a history of “nearmiss” SIDS at age 6 weeks who died suddenly and unexpectedly in her sleep 12 years later may reflect an important and unappreciated aspect of the natural history of SIDS.