OAD progresses despite removal of alloimmunity if the initial period of alloimmune injury is sufficient. Airway epithelial loss correlated with progression to fibroproliferation, suggesting that the epithelium plays a significant role in the pathogenesis of OB.

Since the descriptions by Dr Rothmund in 1868 1 and by Dr Thomson in 1923, 2 less than 250 cases of RothmundThomson Syndrome (RTS) have been reported in the medical literature. Acute photodistributed reticular erythema with poikiloderma is consistently present, in keeping with the seminal descriptions. 2 Growth retardation, radial ray malformations, juvenile cataract, and a predisposition to malignancies may also be present. 3,4 Bronchiectasis is an uncommon disease in children that can lead to severe illness. 5 Lower respiratory tract infections in patients with RTS have rarely been described, 6,7 but bronchiectasis has never previously been reported. We report two cases of RTS in which localized bronchiectasis developed. Case reports Patient 1This European girl born in 1990 was the second child of nonconsanguineous parents. She was born at full term with normal weight (3.2 kg) and length (50 cm). RTS was suspected at 5 months of age and diagnosed at 16 months of age because of development of reticular erythema on face and dorsal aspects of the hands, followed by facial poikiloderma and erythema, together with sparse eyebrows and onyxis. Spots of skin hypoor hyperpigmentation developed later. There were no limb abnormalities or cataract. Growth was moderately retarded (−1.5 SD for height and −2 SD for weight). Puberty occurred at the normal age. A karyotype on skin fi broblasts showed multiple spontaneous chromosome breaks (1, 2, 6, 15, 16), whereas a nucleotide excision repair study (recovery of RNA synthesis) on skin fi broblasts revealed normal results. She was suggested as being a compound heterozygote for the mutations in the RECQL4 genes: (1048-1049delAG) in exon 5 and (1149G>A/ W383X) in exon 6.Upper and lower respiratory tract infections occurred early in childhood and were followed by a history of chronic bronchitis with copious sputum production. Atelectasis of the left lower lobe was fi rst observed on a chest radiograph taken at 18 months of age. At 6 years old, localized bronchiectasis was found in the left lower lobe and confi rmed by computed tomography (CT) scan of the chest ( Fig. 1a). Pulmonary function tests (PFT) performed prior to surgery were normal ( Table 1). Due to recurrent bronchitis exacerbations originating from the focus of bronchiectasis (confi rmed on endoscopic fi ndings), a left lower lobectomy was performed at 6 years of age. After a brief improvement, the respiratory symptoms recurred. Another focus of bronchiectasis was found in the left Fowler lobe at 8 years of age and was removed by partial lobectomy 3 years later. This second procedure produced a sustained clinical improvement. The sweat test and ciliary motility study were normal. There was no previous clinical history of chronic aspiration and pH study was normal. Several routine immunological investigations were normal ( Table 2). Patient 2This European boy born in 1990 with normal birthweight (3.1 kg) and length (49 cm) was the fi rst child of non-consanguineous parents. Radial and thumb hypoplasia were observed at bi...

In immunocompromised patients, clinical manifestations of human parvovirus B19 (PVB19) infection are mostly reported as acute or chronic hematological disorders. Recently, PVB19 infection has been associated with nonhematological symptoms. Four years after lung transplantation, a 9-year-old girl developed a severe anemia with reticulocytopenia requiring blood transfusion. PVB19 DNA was found by polymerase chain reaction in blood. Blood marrow aspiration revealed typical features of PVB19 infection. She was successfully treated with high dose of i.v. Ig. Then, she exhibited recurrent nonregenerative anemia requiring another course of i.v. Ig. PVB19 DNA has been persisted in blood with no specific immune response. At the same time, she suffered from several lung infection syndromes with no microorganism found except PVB19 DNA. Recurrent mild renal dysfunction was noticed with no other explanation than PVB19 infection. This report indicates that pediatric transplanted patients are at risk of chronic PVB19 infection, which can be associated with lung and/or renal disorders.

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