Disseminated invasive infection due to Metarrhizium anisopliae in an immunocompromised child

The first reported human case of possible disseminated infection with the insect pathogen Metarrhizium anisopliae var. anisopliae, a fungus which has been used commercially for biocontrol of insects, is described. The patient, a 9-year-old boy, had a 5-year history of pre-B-cell acute lymphoblastic leukemia and had been on chemotherapy throughout this period. After 10 days of profound neutropenia, lesions consistent with ecthyma gangrenosum appeared on his arms and legs. M. anisopliae was grown from specimens from three separate sites, collected at different times over a period of 1 month: a skin biopsy, a swab from the base of a lesion, and the core of another skin lesion which spontaneously discharged. The initial skin biopsy also showed histological evidence of epidermal necrosis and dermal invasion with fungal hyphae. A computed-tomography (CT) scan of the chest demonstrated a lesion in the superior segment of the lower lobe of the left lung. A CT scan of the brain revealed a lesion in the left temporoparietal region of the brain, consistent with an abscess. Despite antifungal treatment including liposomal amphotericin and 5-flucytosine, the patient eventually died. The initial portal of entry is unknown, but hematogenous dissemination to the skin appears likely because of the multiple ecthymic lesions, and the appearances of the brain lesion on the CT scan are consistent with a hematogenous fungal abscess.     

Disseminated acanthamoeba infection in patients with AIDS: case reports and review

Acanthamoeba infection has been described as an opportunistic infection in persons with AIDS. We report two cases of patients with AIDS and acanthamoeba infection and review the manifestations of this protozoan infection in patients infected with human immunodeficiency virus. The diagnosis of this infection requires a high index of suspicion because the clinical and histologic manifestations may be confused with those of disseminated fungal or algal disease. Clinicians and laboratory personnel should be aware of this potentially fatal condition so that appropriate diagnostic studies can be performed and treatment can be urgently administered. Early initiation of therapy may alter the clinical outcome of the disease.     

Visual agnosia with bilateral temporo-occipital brain lesions in a child with autistic disorder: a case study

A 2-year-old boy meeting the criteria for autistic disorder was diagnosed 2 years later with a visual agnosia characterised by a combination of certain aspects of associative and apperceptive agnosia. MRI then revealed a severe encephalomalacia of the right temporal lobe and bilateral temporo-occipital areas. This association is discussed in terms of a clinical and aetiological relation between autistic disorder and visual agnosia.     

Leiomyosarcoma of the kidney in an HIV-infected child

Spindle cell tumors (leiomyoma and leiomyosarcoma) have been described in immunocompromised children after transplantation and in association with HIV infection. Previous reports have described tumors of respiratory (lung, bronchi), gastrointestinal (stomach, bowel, liver), and subcutaneous origins. We report a case of leiomyosarcoma of the kidney in an HIV-infected child.     

Itraconazole responsive tinea capitis in an HIV-infected child

Cytopenias following bone marrow transplantation may be severe and life-threatening. These have been described post-allogeneic Klumpp, 1991: Bone Marrow Transplant 8:159-171. or post-autologous bone marrow transplants Khouri et al., 1994: J Clin Oncol 12:748-758. as well as with peripheral blood stem cell transplantation Klumpp et al., 1992: Am J Hematol 41:215-217. It can be immune mediated, associated on occasions with graft-versus-host disease (GVHD) Anasetti et al., 1989: Blood 4:1054-1058; however, in most cases, the underlying mechanism is uncertain. The treatment of post-transplant cytopenias is not well established, and they are often refractory to immunosuppressive therapy with steroids. Herein we describe two cases of neutropenia after allogeneic bone marrow transplantation that improved after therapy with high-dose intravenous immunoglobulin.     

Disseminated histoplasmosis associated with disseminated tuberculosis: a case report

Disseminated histoplasmosis is reported in a 70-year-old White man. There was also evidence of a previous disseminated tuberculosis infection. This is the 9th reported case of disseminated histoplasmosis in the Republic of South Africa.     

Effectiveness of bacillus of Calmette-Guerin (BCG) vaccination against tuberculous meningitis: a case-control study

A hospital-based pair-matched case-control study was carried out at Government Medical College Hospital, Nagpur to estimate the effectiveness of bacillus of Calmette-Guerin (BCG) vaccination against tuberculous meningitis. The study included 92 cases of tuberculous meningitis in the age group of 0-12 years and equal number of controls, matched for age, sex and socio-economic status. The protective effectiveness and prevented fraction were higher for the subjects in the age group of 0-6 years, males and subjects from upper strata of socio-economic class. The overall vaccine effectiveness and prevented fraction were estimated to be 86.54% (70.38-93.88%) and 65.54% (39.22-80.64%) respectively. Results of this study thus indicated that BCG vaccination was highly effective against tuberculous meningitis and played significant role in its prevention, in this population.     

Psychogenic visual disorders in an abused child: a case report

A 17-yr-old female, classified as retarded educable, was found to have uncorrected visual acuity of 20/800 in both eyes, unimproved by a pinhole disc. A low myopic correction determined objectively did not improve her visual acuity. Tangent-screen studies uncovered neurasthenic spiral fields superimposed on hysterical tubular contractions of both eyes. Investigation uncovered a history of child abuse since infancy. To rule out organic lesions of the oculocalcarine visual pathways, the patient was referred for electrodiagnostic evaluation. Her visual evoked responses were found to be normal. With the use of strong suggestion, her visual fields were brought out to normal limits and her visual acuity with correction was improved to 20/20 in each eye. With the cooperation of her school counselor, the patient was referred for psychiatric evaluation and therapy.     

Multiple cutaneous epithelioid hemangioendothelioma: a case with spindle cells

A case of multiple cutaneous epithelioid hemangioendothelioma (EH) in a Japanese male is reported. The patient was a 52-year-old Japanese bureaucrat. Clinically, about 10 purplish-red, elastic soft or hard papules and nodules had appeared on both lower extremities and the left buttock over the past 20 years. They were excised, but some of them recurred. Histologically, the papules and nodules were well-circumscribed tumors located in the superficial and deep dermis. They appeared to arise from medium-sized vessels and were composed of proliferations of characteristic epithelioid endothelial cells with intracytoplasmic vacuolization and spindle cells. No other extracutaneous tumors were found. We diagnosed the present case as multiple cutaneous EH with spindle cells. The presence of epithelioid endothelial cells and absence of pleomorphism and mitoses of nuclei of spindle cells made differential diagnosis from Kaposi's sarcoma possible. The protracted clinical course seems characteristic of EH in various organs including skin.     

Disseminated intrathoracic desmoplastic small round-cell tumor: a case report

OBJECTIVE: To identify risk factors associated with complicated eclampsia. METHODS: Twenty-four patients with eclampsia complicated by intracerebral hemorrhage, pulmonary edema, renal, hepatic, or respiratory failure, disseminated intravascular coagulation, abruptio placentae, pulmonary aspiration, or hemolysis, elevated liver enzymes, low platelets syndrome were compared retrospectively with 101 uncomplicated eclamptic controls. Information on maternal demographic factors, medical and obstetric histories, and maternal and perinatal outcomes was retrieved and analyzed by univariate and multivariate analysis. RESULTS: By multiple logistic regression, the only risk factors associated with the development of complicated eclampsia were maternal age over 26 years (adjusted odds ratio [OR] 6.3, 95% confidence interval [CI] 2.17, 18.48), multiparity (adjusted OR 4.5, 95% CI 1.55, 13.60) and no prenatal care (adjusted OR 3.3, 95% CI 1.25, 9.60). CONCLUSION: Maternal age above 26 years, multiparity, and no prenatal care are the maternal risk factors identified for the development of complicated eclampsia.     

Gastrostomy-related pancreatitis in a child: a fatal case

A case of acute pancreatitis following gastrostomy feeding tube insertion is presented. This is a rare and fatal complication, which has not been described before. The role of the gastrostomy catheter and total enteral nutrition in the causation of acute pancreatitis is discussed. Pathologists and clinicians should be aware of this disastrous and potentially avoidable condition.     

Inflammatory pseudotumour of the trachea: report of a case in an eight-year-old child

A polypoid inflammatory pseudotumour was diagnosed in the trachea of an eight-year-old child who presented with asthmatic symptoms. The tumour showed 80 per cent blockage of the lower trachea and consisted of proliferating spindly fibroblastic cells admixed with a variable number of inflammatory cells. The literature on childhood inflammatory pseudotumours is reviewed together with the differential diagnosis of other polypoid mesenchymal tumours of the trachea.