Swelling of the right ankle and purpura on the bilateral lower extremities of a 6-year-old boy indicated a diagnosis of Henoch-Schönlein purpura (HSP). The patient was referred to our hospital because of severe abdominal pain that was unresponsive to prednisolone. Respiratory symptoms and pulmonary infiltrates on chest X-ray were absent upon admission. Methylprednisolone pulse therapy gradually improved the abdominal symptoms, but tachypnea developed, and insufficient aeration of the right lung was accompanied by a decline in percutaneous oxygen saturation from 99% to 90% and a rapid decrease in hemoglobin levels from 11.7 to 7.6 g/dL. Chest X-rays and high-resolution computed tomography scans showed widespread consolidation and patchy opacities predominantly in the right lung fields, suggesting acute pulmonary hemorrhage. Intravenous cyclosporin A (CyA) gradually resolved the pulmonary hemorrhage and respiratory insufficiency. Pulmonary hemorrhage, as a complication of HSP, is extremely rare and sometimes fatal. Aggressive steroid and immunosuppressive treatment is required to address severe complications of HSP.

Summary:Purpose: To reveal the efficacy of single-dose treatment with chloral hydrate (CH) for clustering seizures in benign convulsions with mild gastroenteritis.Methods: We retrospectively studied the details of treatment in 33 patients with ages ranging from 7 to 39 months. The timeseries records of seizures and processes of drug administrations were investigated.Results: A single-dose therapy with CH was effective in 19 of 22 patients (86%), and diazepam in two of 16 (13%). The doses of CH in patients having a successful treatment with single-dose therapy ranged from 41.7 to 62.5 mg/kg (mean 50.2). In two patients, seizures were resistant to single-dose CH therapy, and their doses of CH were 33.8 and 35.1 mg/kg.Conclusions: An advantage of the single-dose therapy with CH was shown. We recommend treatment with a sufficient dose of not less than 40 mg/kg of CH.

The purpose of this study was to investigate serum KL-6 levels in an infant with Langerhans cell histiocytosis (LCH) and pulmonary involvement. The histologic diagnosis of LCH was established by skin biopsy. Imaging of the chest confirmed marked interstitial shadowing throughout both lung fields. Acutely, serum KL-6 was elevated to 9,400 U/mL. Following induction chemotherapy, clinical manifestations of LCH improved and the levels of serum KL-6 returned to within normal limits. During the maintenance therapy phase, there was a resurgence of the LCH, but without involvement of the lungs, and the levels of KL-6 remained normal. The authors conclude that KL-6 may be a useful marker for pulmonary involvement in infants with LCH.

Unilateral spatial neglect (USN) is a relatively common neurological disorder observed in patients after brain injury. Patients fail to attend to the contralesional side of space (1). Although USN is well documented in adults, it has been rarely reported in children (2-10). We present a child showing USN during an attack of hemiplegic migraine, without structural brain injury. The present report is the first in which USN during migraine is described.

Enterovirus 71 (EV71) is a common cause of hand, foot and mouth disease (HFMD) and herpangina in children, both of which are mild self-limiting disorders. However, EV71 infection can also lead to neurological complications, including aseptic meningitis, encephalitis and poliomyelitis-like syndrome. Outbreaks of EV71 infection have occurred in many countries. These epidemics included cases of HFMD and herpangina that developed meningitis, coma, pulmonary edema or left ventricular dysfunction without cardiomegaly, leading to unexpected sudden death. Histopathological fi ndings of fatal cases at autopsy revealed severe widespread infi ltration of mononuclear cells in the gray matter of the brain stem and spinal cord, accompanied by degeneration and necrosis of the neurons, with no evidence of infl ammation of the myocardium or lungs. 1 EV71 was isolated from the throat, feces, cerebrum and brain stem of fatal cases, but not from the myocardium, pericardium or lungs. 1 These fi ndings are consistent with brain stem encephalitis due to EV71 infection. Despite treatment with assisted ventilation, positive inotropic agents and/or vasodilation, most cases of EV71 infection with pulmonary edema result in a fatal outcome.Recent advances have been made in the development of mechanical cardiopulmonary support systems. In particular, intra-aortic balloon pumping and percutaneous cardiopulmonary support (PCPS) are now widely used for the resuscitation and support of patients with cardiac arrest, cardiogenic shock, pulmonary insuffi ciency and pulmonary edema. Here, we describe a severe case of EV71 encephalitis with pulmonary edema and left ventricular dysfunction, in which the patient survived after emergency treatment with PCPS. CaseA 3-year-old boy with no signifi cant medical history presented with fever and vesicles on his hands and feet. He was admitted to a hospital the following day due to frequent vomiting. Laboratory tests revealed levels of infi ltrating cells in the cerebrospinal fl uid (CSF) of 65/ L, a white blood cell count of 15 500/ L and glucose levels of 553 mg/dL. The patient was transferred to Seirei Hamamatsu General Hospital, Shizuoka, Japan, on the same day, after he developed unconsciousness, left ventricular hypokinesia on echocardiography and pulmonary insuffi ciency following intubation. His vital statistics at the time of admission were as follows: temperature 41.0°C, heart rate 218 beats/min and systolic pressure 58 mmHg. Pulse oximetry showed 100% saturation at an FiO 2 of 1.0. A chest X-ray revealed hilar dominant homogenous shadows and a cardiothoracic ratio of 46%. Chest computed tomography showed a homogenous shadow and an air bronchogram in the bilateral lung fi elds. These fi ndings were consistent with pulmonary edema. His laboratory data were as follows: white blood cell count 6220/ L, red blood cell count 529 × 10 4 / L, hemoglobin 13.1 g/dL, hematocrit 41.0%, platelet 24.3 × 10 4 / L, aspartate aminotransferase 198 IU/L, alanine aminotransferase 20 IU/L, lactate dehydrogenase 1030 IU/L,...