Palpebral Edema Research Articles

<i>Congenital Analbuminemia</i>

Congenital analbuminemia (CAA) is a rare autosomal recessive disorder, characterized by the absence or very low level of serum albumin (human serum albumin/HSA) as a result of defect on chromosome 4 which encodes albumin. It is defined as albumin level <1 g/l with normal liver function and the absence of protein loss.1,2 Estimated CAA prevalence is less than 1 in 1 million.A 10-year-old boy suffered from generalized edema that got worsened since last month. The patient had been misdiagnosed with nephrotic syndrome 2 years earlier, and then became protein-losing enteropathy. Neither cough nor diarrhea were reported. The patient had history of food allergy. Physical examination showed moderately ill condition, Glasgow Coma Scale (GCS) score E4 V5 M6, blood pressure 90/50 mmHg, pulse 120 x/min, respiratory rate 30x/min, palpebral edema, shifting dullness, undulation (+), with nonpitting edema on the extremities. Laboratory findings: leukocytosis (neutrophilia), peripheral blood smear showed hypochromic microcytic anisositosis erythrocyte. AAT serum 246 mg/dl, GGT serum: 88 U/l, iron serum 28 µg/dl, TIBC 411 µg/dl, transferrin saturation 7%, total IgE 775,90 U/ml. Serum Protein Electrophoresis (SPE) results were hypoalbuminemia (1,4 g/dl), hypogammaglobulinemia (0,21 g/dl), and total protein 2,91 g/dl. Chest X-ray showed pneumonia with minimal right pleural effusion. Overestimation of serum albumin level was caused by alpha and beta globulin that were detected as albumin in bromocresol green (BCG) methods. CAA aggravated with by allergy caused malnutrition in this patient. These data support the diagnosis of CAA with sepsis and iron deficiency anemia. Suggestion for the management consist of blood culture, procalcitonin level measurement, inguinal lymph node biopsy, DNA sequence analysis, also analysis of pleural and ascites fluid.

À propos d’un cas pédiatrique d’allergie au kaki

Food allergy to persimmon (Diospyros kaki) is exceedingly rare. We report a case involving a 3.33-year-old child who experienced an episode of palpebral edema with pruritus and facial erythema following the first ingestion of this fruit. Allergological investigation reveals a biological sensitivity to persimmon, with specific immunoglobulin E levels at 0,79 kU/L, as well as a positive skin prick tests to persimmon fresh extract. An oral provocation test was also conducted, demonstrating no reaction to the ingestion of 1 then 2 grams of persimmon, but a similar reaction to the initial episode when ingesting 5 grams (resulting in a total cumulative dose of 8 grams). Our observation describes the pediatric manifestations of this allergy along with a literature review.

TRABECULECTOMY IN CLOSED ANGLE UVEITIS GLAUCOMA A CASE REPORT

Introduction : Glaucoma uveitis is caused by increased outflow resistance, which distorts the balance between water production and outflow. Trabeculectomy is better than LPI in controlling IOP in glaucoma uveitis
 Case Illustration : Male patient aged 45 years, came to the Eye Polyclinic at Serui Hospital with complaints of very painful right eye since 2 weeks ago, the patient also complained of being unable to see at all, red eyes, headache, stiff neck, nausea and vomiting. Ophthalmological examination reveal right eye vision no light perception (NLP), palpebral edema, spasm, conjunctival hyperemia, corneal edema, shallow anterior chamber angle, iris-corneal contact, negative pupillary reflex, total pupillary block, negative fundus reflex, schiotz IOP 81 mmHg.
 Discussion : The patient diagnosed as right eye acute glaucoma and treated with acetazolamide, timolol maleate eye drops, potassium aspar tablets, prednisolone acetate drops, diclofenac sodium drops in the right eye, paracetamol tablets, re-evaluate in 2 hours. The patient chose to be referred to a hospital in Surabaya. The patient came back with the same complaint and was treated the same as before, right eye surgery trabeculectomy + peripheral iridectomy with releaseable suture flap limbal base with controlled IOP results, releaseable suture sutures were removed in 2 weeks. Trabeculectomy of the uveitic eye is generally less successful because of accelerated wound healing by the postoperative fibrinous and cellular response. Antimetabolites such as 5FU and Mitomycin C are used to enhance the success of trabeculectomy in uveitis eyes (5FU, MMC). 95% success (IOP less than 21 mm Hg with 1 or no treatment) was achieved with MMC augmented trabeculectomy.
 Conclusion : Increased IOP due to pupillary block causes acute glaucoma with signs of high IOP, middilated pupils, decreased pupillary reflexes, and irregular shape, corneal epithelial edema, episcleral and conjunctival vascular congestion, shallow anterior chamber, small number of flares and cells.

TRABECULECTOMY IN CLOSED ANGLE UVEITIS GLAUCOMA A CASE REPORT

Introduction : Glaucoma uveitis is caused by increased outflow resistance, which distorts the balance between water production and outflow. Trabeculectomy is better than LPI in controlling IOP in glaucoma uveitis
 Case Illustration : Male patient aged 45 years, came to the Eye Polyclinic at Serui Hospital with complaints of very painful right eye since 2 weeks ago, the patient also complained of being unable to see at all, red eyes, headache, stiff neck, nausea and vomiting. Ophthalmological examination reveal right eye vision no light perception (NLP), palpebral edema, spasm, conjunctival hyperemia, corneal edema, shallow anterior chamber angle, iris-corneal contact, negative pupillary reflex, total pupillary block, negative fundus reflex, schiotz IOP 81 mmHg.
 Discussion : The patient diagnosed as right eye acute glaucoma and treated with acetazolamide, timolol maleate eye drops, potassium aspar tablets, prednisolone acetate drops, diclofenac sodium drops in the right eye, paracetamol tablets, re-evaluate in 2 hours. The patient chose to be referred to a hospital in Surabaya. The patient came back with the same complaint and was treated the same as before, right eye surgery trabeculectomy + peripheral iridectomy with releaseable suture flap limbal base with controlled IOP results, releaseable suture sutures were removed in 2 weeks. Trabeculectomy of the uveitic eye is generally less successful because of accelerated wound healing by the postoperative fibrinous and cellular response. Antimetabolites such as 5FU and Mitomycin C are used to enhance the success of trabeculectomy in uveitis eyes (5FU, MMC). 95% success (IOP less than 21 mm Hg with 1 or no treatment) was achieved with MMC augmented trabeculectomy.
 Conclusion : Increased IOP due to pupillary block causes acute glaucoma with signs of high IOP, middilated pupils, decreased pupillary reflexes, and irregular shape, corneal epithelial edema, episcleral and conjunctival vascular congestion, shallow anterior chamber, small number of flares and cells.

Challenges in Diagnosing and Initial Treatment of Advanced Eyelid Basal Cell Carcinoma in Rural Area: A Case Report

Introduction : Basal cell carcinoma (BCC) is the most common non-melanoma eyelid cancer with a high risk of recurrence. This case report discusses the management of extensive BCC in a rural setting with limited resources.
 Case Illustration : A 62-year-old Timorese female, presented to the hospital with a mass on the left periocular region. It appeared as a mole in the lower left eyelid and extended to the surrounding tissues over nine years. As a farmer, she was frequently sun-exposed. A blackish mass was found at the left orbit, buccal, and entire nose (8 x 7.5 cm) with an ulcerated surface and attached firmly. The right eye had bedside visual acuity >6/60, with palpebral edema, free eye movement, hyperemia nasal conjunctiva, and transparent cornea. The left eye is difficult to examine. Two submandibular lymphadenopathies were palpated. A Head CT scan showed a suspected malignant soft tissue mass with irregular thickening of soft tissue with ill-defined borders. Histopathology examination revealed a nodulocystic type of basal cell carcinoma.
 Discussion : Locally advanced BCC cases need a multidisciplinary approach. In a limited resources setting, the treatment highlights are histological diagnosis, complete surgical excision, and exenteration with margin control. From a broader perspective, the role of primary health care in educating and revering for early treatment is paramount.
 Conclusion : Prevention and early treatment are the most important factors in managing locally advanced BCC.

A Case: The Strategy of Corneal Ulcers

Introduction : Corneal ulcers are considered an ophthalmologic emergency because of their potential to permanently impair vision or perforate the eye. Accurate and quick diagnosis and prompt treatmentis a key to improve clinical and visual outcomes in cases of corneal ulceration.
 Case Illustration : In this paper, we present the case of male 40-year-old presented with complaints of pain and defective vision in the right eye. Visual examination of the right eye is 1/~. It was found, palpebral edema, hyperemic tarsal conjunctiva. The bulbar conjunctiva showed conjunctival injection, ciliary injection. The cornea looks completely cloudy, the surface is not slippery, infiltrates and edema. The patient was treated with medical and surgical therapy, and then the patient’s have a good clinical response and was able to return to work.
 Discussion : The diagnosis of corneal ulcers was established based on history, physical examination and clinical examination using a slit lamp and laboratory examinations. Patient's examination revealed the presence of Candida albicans. This examination is important to distinguish the cause of the corneal ulcer so that it can help select an adequate therapy.
 Conclusion : Indonesian farmers have highrisk of fungal corneal ulcers. Fungal corneal ulcers is important cause of corneal blindness all over the world especially in develoving countries. Fungal corneal ulcers can diagnosis by slitlamp biomicroscopic examination and culture are essential for early specific diagnosis and must be taken consideratiaon to establish the most effective treatment and avoid severe complications

Enucleation and Dermato-fat Graft for Retinoblastoma Management : A Case Report

Introduction : Retinoblastoma is the most common intraocular malignant tumor found in children before 3 years old can occur unilaterally, bilaterally, hereditary or sporadic. Incidence of about 1:14,000-20,000 individuals. This tumor originated from embryogenic retinal cells. Retinoblastoma gene (RB1) located in the 13q14 chromosome
 Case Illustration : A 3-year-old girl presented with leukocoria. Her parents notice whitish in her right eye swollen, teary, painful since 2 months ago. No family history. Visual acuity (VA) on the oculus dextra ( OD) no light perception, oculus sinistra (OS) 6/6. Intraocular pressure on OD n-1/palpation, OS n/palpation. Examination under anasthesia for diagnostic found there weren’t palpebral edema, conjunctival injection, hazy cornea, pupil, lens couldn’t be evaluated on OD. Ultrasound showed sugest vitreous seeding and ptisis. CT scan showed solid mass with calcification and diagnosed retinoblastoma stage group E. Patient was treated with chemoreduction using Vincristine, Etoposide, Carboplatine combined enucleation with dermato-fat graft. We did nervus opticus dissection and histopathological examination which showed retinoblastoma.
 Discussion : The common signs of retinoblastoma is leukocoria. The priority is saving life followed by globe preservation. Treatment based on the stage of the disease. We did chemotherapy in this patient, followed by enucleation and dermato-fat graft. Enucleation stills the main therapy for saving life with nervus opticus dissection as possible. Dermato-fat graft has been shown to grow along with the expanding orbit in children therefore shows cosmetics.
 Conclusion : This report illustrates a case of Retinoblastoma. The chemotherapy and enucleation using safe dermato-fat graft procedure with implant followed by a well fitted prosthesis for better cosmetics

Chemical Eye Burn Injury Due to Polyester in Industrial Worker: A case report

Introduction : Chemical eye burns are common causes of work-related eye injuries. Prompt and appropriate emergency management may be the most important factor in determining the visual outcome.
 Case Illustration : A 50-year-old man who works in a plastic factory immediately went to the emergency room after being exposed to melted polyester in his right eye. He complained of hurt and hotness in his eye. The emergency primary survey was stable. Triage of ophthalmology was an emergency. Initial Uncorrected Visual Acuity (UCVA) was light perception with correct projections. Physical examination revealed 2nd-degree combutio on the forehead and left cheek. Anterior right eye examination revealed palpebral edema, polyester debris on the eyelid, conjunctival mixed injection, ischemia of less than 1/3 of the limbus, corneal edema, corneal opacity, and polyester sticking to the cornea. The damage was determined as Roper-Hall grade II. In the Emergency room, Eye was immediately irrigated with 1 L of normal saline. A referral was made to the ophthalmologist and Immediate debridement was carried out. Wide corneal erosion was found after the procedure. Treatment was continued with antibiotic eye drops, lubricant eye drops, oral vitamin, and oral analgetic. The patient had improved visual acuity to 20/20 f2 with corneal scar and opacity 1 month after surgery.
 Discussion : The combined management of this case consisted of ocular lavage, surgery, and medication. A Chemical Eye Burn requires immediate management to prevent extensive damage leading to visual impairment.
 Conclusion : Initial treatment in the emergency department and referral to the ophthalmologist can improve patient outcomes.

Moxifloxacin Treatment for Contact Lens-Related Corneal Ulcer: A Case Report

Introduction : A corneal ulcer is an ophthalmological emergency that can threaten vision. It is characterized by inflammation or infection involving the corneal epithelium and stroma. Prolonged use of contact lenses is more likely to cause corneal ulcers. The purpose of this paper is to report on the management of corneal ulcers.
 Case Illustration : A 30-year-old female complained of blurred vision, redness, pain, swelling, and sensitivity to light in both eyes for the last two days. She reported falling asleep in her contact lenses two nights before the visit. The patient had compound myopic astigmatism before and her visual acuity was decreased to 3/60 in the right eye and 5/60 in the left eye, examinations showed palpebral edema and conjunctival hyperemia in both eyes. The use of fluorescein in both eyes highlighted the area of the defect. The patient was diagnosed with corneal ulcers. Treatments were Moxifloxacin Eye Drop every hour and Ibuprofen 2x400 mg by intravenous infusion. On the last visit, the corneas were clear with visual acuity 6/15 in both eyes.
 Discussion : According to the study by Kishor et al., ophthalmic eye drop is the most effective treatment and fourth-generation fluoroquinolones represent the most frequently used strategies in Corneal Ulcer.Conclusion : Antibiotics and analgesics are effective for the management of corneal ulcers in this patient. Education regarding contact lenses is important to prevent the occurrence of corneal ulcers.

P-65 A case of relapse of Graves ophthalmopathy due to an ophthalmic herpes zoster infection in a thyroidectomized patient with multiple comorbidities

Abstract Introduction Graves ophthalmopathy usually occurs in patients with hyperthyroidism or a history of Graves disease, but it can appear in euthyroid patients or patients with chronic thyroiditis also. It is a possible cause of sight-threatening eye disease. Its incidence is 16 for women and 3 cases for men, per 100 000 population but more severe in men, and it's higher among smokers. In mild forms, treatment can be local, but in severe cases and recurrences, systemic glucocorticoids are compulsory, with or without immunosuppressive drugs, surgery or radiotherapy. in recurrences. Clinical Case We present the case of a 76-year-old male, former smoker, diagnosed with Graves disease in 2017. He was treated with anti-thyroid treatment and in 2018 he was thyroidectomized. He also developed a progressive Graves ophthalmopathy from April to July 2017 with a reduced visual acuity for both eyes, conjunctival erythema, palpebral edema and erythema. He received methyl-prednisolone (MP) pulse therapy 6×125 mg weekly with favorable outcome. In 2019, he underwent a recession of internal rectus and inferior rectus for both eyes to correct a divergent strabism and his eye-sight improved. He presents now for an aggravation of the ophthalmopathy after an episode of a herpes zoster infection affecting the ophthalmic branch of the trigeminal nerve. He also suffers from heart failure NYHA III, permanent atrial fibrillation, large aortic stenosis, asymptomatic hyperuricemia, secondary pulmonary hypertension and chronic kidney disease stage IIIb. His medical history revealed hypercholesterolemia, hyperuricemia, heart failure, insufficient status of vitamin D3 and confirmed the chronic kidney disease stage IIIb; normal thyroid function but with high anti TSH receptor antibodies (TRAb=18.37 U/L). Given the age and the comorbidities but also the high activity of the Graves disease and the orbital CT that revealinged a great hypertrophy of the ocular muscles, our ophthalmologist suggested methyl-prednisolone pulse therapy in a standard regimen, but our cardiologist contradicted it because of the heart conditions. As the patient's left eye sight was only 2% and for the right one 20%, we decided to adapt the doses of the pulse therapy and closely monitor the patient. The first dose was 125mg MP, after that 7 doses of 250mg MP weekly was followed by 3 doses of 125mg MP weekly. After a total of 2250 mg MP at a 3 months follow-up, the patients’ eyesight improved to 60% on the left eye and 75% on the right eye and a lower level of TRAb=5.59 UI/L. Conclusion Even in patients with comorbidities where corticosteroid therapy may be detrimental, there is a possibility to adapt the doses in a safe way and with a continuous clinical monitoring so that the patients’ eyesight can be saved, therefore increasing the quality of life.

Multilayered-Amniotic Membrane Transplantation in Gunshot Powder Injury: A Case Report

Background: Amniotic membrane transplantation has been widely used to repair various ocular surface conditions, including inflammatory, infectious, traumatic, and neoplastic conditions, with satisfactory results. a case of a 34-year-old male hit by a gunpowder explosion.
 Case presentation: We reported a case of a 34-year-old male hit by a gunpowder explosion. The right eye was hyperemic and felt blurry after the incident. On examination of the right eye, visual acuity was 20/150, and foreign bodies and erosion were found in the cornea. The patient planned to do foreign body extraction followed by a multilayered-amniotic membrane transplantation (ML-AMT) procedure. On the first and second day of follow-up, on the right eye, the visual acuity was 1/300, palpebral edema was decreased, and subconjunctival hemorrhage was found. On the cornea, there were ML-AMT and bandage contact lenses.
 Conclusion: Gunshot powder injury in the eyes is quite rare. The damage that can occur ranges from corneal epithelium abrasion to perforation and rupture of the eyeball. AMT has been successfully used in the management of eye trauma with defects on the ocular surface.

Genetic and Pathogenic Characteristics of an Emerging Highly Virulent Recombinant Lineage Korean Clade C PRRSV Strain

A strain of porcine reproductive and respiratory syndrome virus (PRRSV) was isolated from lung tissue of a pig showing severe respiratory clinical signs from a farm in Gyeongsang province of South Korea. This PRRSV strain, designated as SNUVR220803, was classified within the lineage Korean clade C (LKC) based on a phylogenetic analysis of the ORF5 gene. A whole‐genome analysis was conducted on the SNUVR220803 strain, which appears to be a recombinant between the PRRSV strains K07‐2273 (part of LKC lineage) and Ingelvac MLV (part of Lineage 5). The Nsp2 amino acid sequence of this strain features a deletion of four additional amino acids, setting it apart from the typical Korean clades A, B, and C lineages. An animal inoculation experiment was conducted with 24 pigs divided into three groups: 12 pigs in the inoculated group, six in the sentinel group, and six in the negative control group. Inoculated pigs exhibited persisting hyperthermia (≥40.3°C) for 5 days, palpebral edema, and cyanosis. Subsequently, these pigs suffered from severe respiratory distress and cachexia, leading to a mortality rate of 58.3% (7 out of 12 pigs) at 14 days postinoculation (dpi). Body weight decreased post‐SNUVR220803 strain infection in both the inoculated and sentinel groups. Gross pathology revealed noncollapsed lungs and serous effusion in the pericardial and peritoneal cavities. Microscopic analysis revealed severe interstitial pneumonia, while immunohistochemistry confirmed the presence of PRRSV antigen in the lungs, lymph nodes, thymus, kidneys, and the heart. Additionally, the levels of cytokines such as tumor necrosis factor‐α (TNF‐α), interferon‐α (IFN‐α), and IL‐10 were significantly elevated in the plasma of infected pigs. These observations indicate that the LKC recombinant strain, combined with Lineage 5, possesses high virulence and infectivity as characterized by distinctive exudative lesions.

Metastatic Neuroblastoma with Initial Orbital Presentation

Neuroblastoma, also called sympathoblastoma, is a malignant embryonal tumor developed at the expense of neural crest cells, the most frequent solid tumor in children under 5 years of age. The objective is to recall the clinical variability and the importance of evoking neuroblastoma in a child presenting with an ophthalmological symptom. We report the case of a 5-year-old child who presented with a right orbital metastatic neuroblastoma, whose ophthalmologic complaint led to the diagnosis. An ophthalmologist in the emergency room for a VAD and eye pain first saw the child. On examination, true exophthalmos with palpebral edema was found on the right. Cerebral and orbital CT revealed a right latero-orbital osteolytic mass of secondary appearance with endocranial extension. The workup showed lymph node involvement, unilateral right adrenal, osteomedullary, hepatic, and pancreatic involvement. The child was admitted to a specialized pediatric oncology department and received chemotherapy. The patient was then declared under palliative treatment.

New daily persistent headache after SARS-CoV-2 infection in Latin America: a cross-sectional study

BackgroundPersistent headache is a frequent symptom after coronavirus disease 2019 (COVID-19) and there is currently limited knowledge about its clinical spectrum and predisposing factors. A subset of patients may be experiencing new daily persistent headache (NDPH) after COVID-19, which is among the most treatment-refractory primary headache syndromes.MethodsWe conducted a cross-sectional study in Latin America to characterize individuals with persistent headache after severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and to identify factors associated with NDPH. Participants over 18 years old who tested positive for SARS-CoV-2 infection and reported persistent headache among their symptoms completed an online survey that included demographics, past medical history, persistent headache clinical characteristics, and COVID-19 vaccination status. Based on participants’ responses, NDPH diagnostic criteria were used to group participants into NDPH and non-NDPH groups. Participant data was summarized by descriptive statistics. Student’s t and Mann–Whitney U tests were used according to the distribution of quantitative variables. For categorical variables, Pearson’s chi-square and Fisher’s exact tests were used according to the size of expected frequencies. Binomial logistic regression using the backward stepwise selection method was performed to identify factors associated with NDPH.ResultsFour hundred and twenty-one participants from 11 Latin American countries met the inclusion criteria. One in four participants met the NDPH diagnostic criteria. The mean age was 40 years, with most participants being female (82%). Over 90% of the participants reported having had mild/moderate COVID-19. Most participants had a history of headache before developing COVID-19 (58%), mainly migraine type (32%). The most predominant clinical characteristics in the NDPH group were occipital location, severe/unbearable intensity, burning character, and radiating pain (p < 0.05). A higher proportion of anxiety symptoms, sleep problems, myalgia, mental fog, paresthesia, nausea, sweating of the face or forehead, and ageusia or hypogeusia as concomitant symptoms were reported in participants with NDPH (p < 0.05). Palpebral edema as a concomitant symptom during the acute phase of COVID-19, occipital location, and burning character of the headache were risk factors associated with NDPH.ConclusionThis is the first study in Latin America that explored the clinical spectrum of NDPH after SARS-CoV-2 infection and its associated factors. Clinical evaluation of COVID-19 patients presenting with persistent headache should take into consideration NDPH.

Acute myelomonoblastic leukemia in children, the particularities of extramedullary infiltration based on a clinical case

Childhood acute myeloidleukemia (AML) represents approximately 5% of childhood malignancies and 15% to 25% of pediatric acute leukemia. The extramedullary manifestation of infiltrating clonal blast populations in a variety of organs and tissues in acute myeloid leukemia (AML) is defined as a distinct entity in the 2016 WHO classification of myeloid neoplasms, myeloid sarcoma The rate of complete remission after induction chemotherapy was lower in patients with extramedullary infiltration, overall survival and event-free survival were not different between patients with and without extramedullary infiltration. Purpose of the study: Presentation of a clinical case of ALM type M4 with the presence of an extramedullary infiltrate in the tissue of the central nervous system in children. Materials and methods: The clinical, paraclinical, imaging data of the patient were studied in parallel with the specialized literature on similar cases. Results: Boy, 5 years old, goes to the doctor with accusations of bilateral palpebral edema, bilateral temporal region edema and bilateral exophthalmos , more pronounced on the left. In the general analysis of the blood: - Hemoglobin - 89 g/l , Leukocytes - 7.2 x 10^9/l; unsegmented neutrophil - 1%; segmented - 18%; lymphocytes - 44%; monocytes - 20%; blast cells - 16%; Platelets - 70 x 10^9/l;VSH - 44 mm/h. During the physical examination: the peripheral lymph nodes are palpable. No signs of central nervous system damage. It is supposed the diagnosis: Acute myeloid leukemia, sarcoma, or neuroblastoma. A medullary puncture: moderately cellular marrow was determined, with blastcells 15.2%. Morphologically, it is more similar to acute myelo-monoblastic leukemia FAB-M4. Computerized Tomography-multiple, hyperdense pathological foci, with localization with inand bilateral extraorbital, associated with exophthalmos. The formation from the sphenoid sinus extends to the nasopharynx , through the pterygopalatine fossa, with narrowing of the lumen and mass effect on the palatine tonsils. Immunophenotyping: CD45-/+ SS low 8% population, CD36+ 6%CD64+ monoblasts 8%, Promonocytes /monocytes – (CD64+/CD14+) 25%.He underwent treatment according to the AML BFM 2004 program with numerous complications, andcranial radiotherapy. At the moment, the child is in morphological remission. Conclusions. The differential diagnosis of hyperdense intracranial masses may include neuroblastoma, meningioma, lymphoma, metastases, or sarcomas. Correct and early diagnosis and initiation of specific treatment are essential to increase the survival rate in cases of acute leukemia in children.

Histaminic Angioedema in Children: A Rare Entity Not to be ignored

Angioedema is a common symptom to different etiologies, the diagnostic orientation is based on the associated signs. The most common are histamine, non IgE-mediated, benign and often associated with urticaria. Angioedema by anaphylaxis and bradykinin angioedemas are rare but potentially severe by upper airway involvement. We report the case of a 14 years old patient with a history of bilateral orbital swelling associated with deep urticaria, and a brother followed for angioedema. Presenting bilateral palpebral and jugal edema, associated with uticarian tasks in the trunk and back. The diagnosis of histaminic angioedema was made and confirmed by the response to corticosteroids and antihistamines, and a biologic workup ruling out differential diagnoses. Treatment was based on the management of the crisis and the implementation of in-depth treatment in the event of recurrent and disabling crises. Measures associated with this drug treatment are also essential, mainly therapeutic education.

Profile of Stevens-Johnson syndrome and toxic epidermal necrolysis patients in the inpatient hospital installation of Dr. Soetomo general hospital Surabaya from January 2019 – December 2021

Background: Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis are significant health issues due to their severe complications. Factors like age, clinical symptoms, and underlying etiology play crucial roles in patient management. Therefore, it is important to review further the background or profile of the patients. This is the basis for conducting this study. This research aims to provide an overview of patients with SJS-TEN in the Inpatient Installation of RSUD Dr. Soetomo Surabaya, aiming to aid in prevention and management. Aim: Providing an overview of the profile of patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis in the Inpatient Installation of Dr. RSUD. Soetomo Surabaya Methods: The study analyzed medical records of patients with Stevens-Johnson Syndrome and Toxic Epidermal Necrolysis at RSUD Dr. Soetomo Surabaya from 2019-2021, analyzing parameters such as gender, age, symptoms, etiology, comorbidities, and length of stay. Results: The study found 28 cases of SJS-TEN, with 15 males (53.6%) and 13 females (46.4%). The highest prevalence was in the age group 19-44 years old as we called adult (35.7%). Most patients had multiple comorbidities, with common clinical symptoms including palpebral edema, multiple erythematous macules, conjunctival erythema, and fever. Most patients were classified as SCORTEN 1, with 71.4% taking multiple drugs. Most patients experienced multiple complications but experienced improvement and continued treatment through outpatient care (57.1%).

Dermatologic and ophthalmologic collaboration in the management of skin manifestations of ocular rosacea

This case is presented to (1) improve the efficacy of the identification and differential diagnosis and to avoid mistreatment of the skin manifestations of ocular rosacea exhibiting a clinical appearance of those of other disorders and (2) explore opportunities for building dermatologic and ophthalmologic collaboration in the management of patients with ocular symptoms of rosacea. A 33-year-old female patient was diagnosed with acne vulgaris and seborrhea oleosa by a dermatologist. She received a secondary diagnosis of adrenal hyperandrogenism, iron deficiency anemia and selenium and iodine deficiency. The patient underwent facial skin peeling and was prescribed dermatological treatment. Thereafter, she presented to an ophthalmologist and complained of gritty eyes and blurred vision which she had never before experienced. Ocular manifestations included macerated skin of the eyelid angles, palpebral edema, crusts at the eyelid margin and eyelid telangiectasia. The patient was diagnosed with ocular rosacea, dry eye and keratoconjunctivitis sicca, and obtained the prescribed ophthalmological treatment which resulted in an improvement in her ocular symptoms. Therefore, ocular rosacea should be treated through the cooperative efforts of dermatologists and ophthalmologists based on the constellation of clinical findings and symptoms in a particular case.

Eosinophilia and potential antibody cross-reactivity between parasites in a child with pinworm and immune dysregulation: a case report

BackgroundIntestinal parasitic infections are common in humans, especially among young children. These conditions are often asymptomatic and self-limiting, and diagnosis is mainly based on the search for ova and parasites in the stools since serology may be biased due to cross reactivity between parasites. Pinworm is common in children and is not usually associated with hypereosinophilia; adhesive-tape test is the gold standard testing for the microscopic detection of Enterobious vermicularis (Ev) eggs.Case presentationA 13-year-old boy was referred due to a self-resolving episode of vomiting and palpebral oedema after dinner, together with a history of chronic rhinitis, chronic cough, absolute IgA deficiency and Hashimoto’s thyroiditis and hypereosinophilia (higher value = 3140/µl). On evaluation we detected only palpable thyroid and hypertrophic nasal turbinates. Food allergy was excluded, but skin prick tests showed sensitization to house dust mites and cat epithelium and spirometry showed a marked obstructive pattern with positive bronchodilation test prompting the diagnosis of asthma for which maintenance inhaled treatment was started. Chest x-ray and abdomen ultrasound were negative. Further blood testing showed positive IgG anti-Echinococcus spp. and Strongyloides stercoralis and positive IgE for Ascaris, while Ev were detected both by the adhesive tape test and stool examination, so that we made a final diagnosis of pinworm infection. Three months after adequate treatment with pyrantel pamoate the adhesive-tape test turned out negative and blood testing showed a normal eosinophil count. The child later developed also type 1 diabetes.ConclusionsWe suggest the need to investigate for enterobiasis in children with hypereosinophilia and to consider autoimmunity as a potential confounding factor when interpreting serology for helminths.

Cardiological Monitoring - A Cornerstone for Pediatric Inflammatory Multisystem Syndrome Temporally Associated with COVID-19 Outcome: A Case Report and a Review from the Literature.

Pediatric inflammatory multisystem syndrome temporally associated with COVID-19 (PIMS-TS) is a rare life-threatening condition requiring a complex management and multidisciplinary approach, whose outcome depends on the early diagnosis. We report the case of a 2 years and-5-month-old boy admitted in our clinic for fever, abdominal pain and diarrhea. The clinical exam at the time of admission revealed influenced gen-eral status, bilateral palpebral edema and conjunctivitis, mucocutaneous signs of dehydration, and abdominal tenderness at palpation. The laboratory tests performed pointed out lymphopenia, thrombocytopenia, anemia, elevated C-reactive protein - CRP, erythrocyte sedimentation rate and ferritin levels, hyponatremia, hypopotassemia, hypertriglyceridemia, elevated D-dimer, in-creased troponin and NT-proBNP. The real-time polymerase chain reaction (RT-PCR) test for SARS-CoV-2 infection was negative, but the serology was positive. Thus, established the diagnosis of PIMS-TS. We initiated intravenous immunoglobulin, empirical antibiotic, anticoagulation therapy and symptomatic drugs. Nevertheless, the clinical course and laboratory parameters worsened, and the 2nd echocardiography pointed out minimal pericardial effusion, slight dilation of the left cavities, dyskinesia of the inferior and septal basal segments of the left ventricle (LV), and LV systolic dysfunction. Therefore, we associated intravenous methylprednisolone, angiotensin converting enzyme inhibitors, spironolactone and hydrochlorothiazide, with outstanding favorable evolution. Echocardiographic monitoring might be a lifesaving diagnostic tool in the management of PIMS-TS.