We describe the case of a 15-year-old boy with a history of Fontan operation and multiple intrahepatic tumors. Computed tomography showed multiple hepatic nodules with arterial enhancement. Because hepatocellular carcinoma (HCC) was not detected on biopsies and tumor markers were normal, progress was monitored on imaging. One hepatic tumor increased greatly in size during follow up. At 15 years of age, tumor markers rose rapidly, and he had upper abdominal swelling. Therefore, transarterial embolization (TAE) was performed for the largest tumor, suspected to be a HCC due to cardiac cirrhosis. This tumor had not increased at follow up 4 months later. The patient died from hepatic failure at the age of 17 years, and HCC was diagnosed at autopsy. Although pediatric HCC is rare, its incidence is likely to increase. TAE, with or without anticancer agents, is a therapeutic option for unresectable pediatric HCC, as it is for adult HCC.
A neonate with herpes simplex virus 1 encephalitis was treated with intravenous acyclovir. During the course of therapy, the infection became intractable to the treatment and a mutation in the viral thymidine kinase gene (nucleotide G375T, amino acid Q125H) developed. This mutation was demonstrated in vitro to confer acyclovir resistance. CASE REPORTA 13-day-old boy was admitted to National Defense Medical College Hospital due to lethargy and failure to thrive. He was born at 39 weeks 5 days of gestation and 2,558 g birth weight to a healthy 35-year-old mother (gravida 2, para 2). Group B streptococcus (GBS) was detected from the mother's vagina in the third trimester, but the baby's bacterial culture tests performed at birth, including throat, skin, and blood analyses, were negative for GBS. The mother did not have a history of genital herpes. Her herpes simplex virus 1 (HSV-1) and HSV-2 serostatus was not examined, and her history of acyclovir (ACV) use was not clear. Furthermore, the genital swab culture examination for HSV was not performed. On admission, physical examination of the boy revealed skin blisters on the forehead and upper lip. A swab from the blister showed positive and negative reactions for the specific antigens of HSV-1 and HSV-2, respectively, in a direct immunofluorescent antibody assay (Denka Seiken Co. Ltd., Tokyo, Japan) performed by a qualified clinical laboratory (SRL Inc., Tokyo, Japan). A serum sample collected on admission showed positive and negative reactions in the enzyme-linked immunosorbent assay for detection of anti-HSV IgM and IgG antibody (SRL Inc.), respectively. A lumbar puncture revealed pleocytosis (547 cells/l) and an elevated protein level (168 mg/dl) in the cerebrospinal fluid (CSF). The CSF was also positive for HSV-1 DNA, which was determined by a previously reported method (1) in PCR testing (SRL Inc.). The boy was diagnosed as having neonatal herpes encephalitis (NHE), and intravenous highdose ACV (60 mg/kg/day) treatment was initiated. His general status improved with resolution of the skin lesions within a few days of the beginning of treatment. However, the viral load in the CSF determined by TaqMan-based quantitative real-time PCR (SRL Inc.), which dropped temporarily, increased again after 4 weeks from the initiation of ACV treatment (Fig. 1A) without obvious deterioration in clinical symptoms. Because the standard dose of ACV was given and drugs which have antagonistic effects for ACV were not used, we assumed that an ACV-resistant HSV-1 strain had developed. The ACV concentration in the CSF was not measured. Foscarnet, an antiviral drug recommended for treatment of ACV-resistant HSV infections (2), was not immediately available. Therefore, vidarabine (15 mg/kg/day) was added to the therapeutic regimen from the fifth week of the treatment course. Subsequently, HSV-DNA in the CSF decreased to a level that was finally undetectable; hence, the antiviral drug treatment was terminated. Because virus isolation from the CSF of the patient was unsuccessful, as is c...
Fetomaternal hemorrhage induced by intraplacental choriocarcinoma is considered to be extremely rare. We herein describe a neonate with severe anemia caused by intraplacental choriocarcinoma that was histopathologically identified after birth. Furthermore, we reviewed three other such cases in Japan. As a result, the incidence of intraplacental choriocarcinoma may be higher than previously estimated. Therefore, we suggest that the placenta should be examined in any suspected cases of fetomaternal hemorrhage.
We report a case of severe fetal anemia associated with maternal anti-M antibody that was treated by direct injection of pooled human immunoglobulin into the fetal abdominal cavity. Four treatments at a dosage of 2 g per-kg estimated fetal body weight were performed, and no side effects were observed. A healthy baby girl was delivered transvaginally at 38 weeks, with neither exchange transfusion nor phototherapy required. Follow-up over 12 months found no indications of anemia or developmental delay in the child. This is believed to be the first report of fetal anemia in a blood-type-incompatible pregnancy being treated successfully with only direct immunoglobulin injection into the fetus. The immunoglobulin may have functioned as a neutralizing antibody causing the anemia to improve.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
customersupport@researchsolutions.com
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
This site is protected by reCAPTCHA and the Google Privacy Policy and Terms of Service apply.
Copyright © 2025 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.