We report on a 7-month-old infant with Kawasaki disease (KD) whose only manifestations were high-grade fever of 7 days duration, "non-toxic look" and "extreme irritability", thereby not meeting the criteria for the classical or the atypical form of the disease. The diagnosis was confirmed by the demonstration of a solitary aneurysm in the proximal left anterior descending coronary artery. The present case raises the concern that the presently laid guidelines for the diagnosis of atypical KD may not be adequate.
Transient affliction of the cranial nerves may at times be either the presenting feature or complication of otherwise uncomplicated Kawasaki disease (KD) in infants and children. The present report describes a 6 year 9 month old boy with classical KD who developed right-sided oculomotor nerve palsy (manifested by ipsilateral ptosis and medial rectus palsy) resulting in symptoms like severe nausea, intense frontal headache and double vision. The palsy resolved within 5 days of intravenous immunoglobulin therapy, with no residual ophthalmological abnormality at 6 weeks. Besides increased intracranial pressure, which commonly occurs during the course of KD in children, secondary to aseptic meningitis, intense headache in such children may have cranial nerve paresis as accentuating factors.
We report on a 7-year-old girl with cerebral vivax malaria complicated by pancytopenia. The diagnosis of malaria was done by demonstration of trophozoites of Plasmodium vivax in the peripheral blood smear and confirmed by both a species-specific antigen detection technique and a sensitive polymerase chain reaction method. There was depression of all 3 blood cell lines. No overt manifestations attributed directly to pancytopenia were noted. The patient responded promptly to artesunate and pancytopenia was managed conservatively. To our knowledge, this is the first report of pancytopenia complicating childhood cerebral vivax malaria in the English literature.
We hereby report a 2-year-old boy who presented with a peculiar combination of hyperpigmented and hypopigmented skin lesions along the lines of Blaschko, sharply demarcated at the midline, both on the anterior and posterior trunk. Although combinations of hyperpigmented and hypopigmented skin lesions distributed along the lines of Blaschko have been described, the combination of skin lesion comprised hypomelanosis of Ito and whorled hypermelanosis distributed in the extremely unusual manner described in this patient has not been reported previously.
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