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ABSTRACT: Three girls of Moroccan descent, aged 9, 10 and 7 years, presented with fever, joint pain and other symptoms. After Streptococcus infection and carditis were confirmed and the Jones criteria for acute rheumatic fever were met, the patients were treated with penicillin and acetylsalicylic acid. All 3 patients recovered. However, the second girl presented 2 months later with cardiac decompensation caused by valve disorders, after which aortic and mitral valvuloplasty was performed. The third girl developed joint pain again after 3 weeks and was diagnosed with juvenile idiopathic arthritis; treatment was adjusted accordingly. The prevalence of rheumatic heart diseases is 10-20 times higher in developing countries than in industrialised nations. The diagnosis 'acute rheumatic fever' should be considered in children of school age with unexplained fever, also when the Jones criteria have not yet been met. This may apply to migrant children in particular.
Nederlands tijdschrift voor geneeskunde 06/2006; 150(20):1101-4.
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ABSTRACT: Four children (two boys aged 1.5 and 10 years and two girls aged 2 and 9 years) vomited for one-half to four weeks. In one child, ataxia was later also noted and another tilted his head constantly to the left, but this was initially not alarming. In all four cases CT revealed a brain tumour, for which they were operated. Postoperatively, one child had residual tumour tissue that caused no further problems, in two children the tumour was completely excised with no further symptoms and no recurrence in the following 2 years, and in one child complete excision was not possible so that chemotherapy and radiotherapy were given, but metastases nevertheless developed 10 months later and the child died. Vomiting is common in children and in most cases the result of infectious or gastrointestinal causes. Intracranial pathology also can cause vomiting, both by increased intracranial pressure and by direct stimulation of the vomiting centre in the brainstem. Brain tumours in children often lack specific neurological signs in their clinical presentation. Intractable or chronic vomiting without nausea or deregulation of the water and electrolyte balance could therefore indicate the presence of an intracranial process, even when other neurological signs are absent.
Nederlands tijdschrift voor geneeskunde 08/2002; 146(30):1393-8.
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ABSTRACT: Two boys of 1 and 16 year had painful buccal lesions and were admitted for dehydration. The younger had finger and toe blisters; the older, severely ill, had conjunctivitis, urethritis and skin lesions. Only symptomatic treatment with lidocaine gel and paracetamol gave good recovery. A 5-year-old Turkish girl had recurrent painful buccal ulcers which each time cleared up spontaneously. Stomatitis is common in childhood. Viral infections are the most common causes of stomatitis, in particular infections with herpes simplex virus (herpes gingivostomatitis), Coxsackie virus (herpangina, hand-foot-mouth-disease), chickenpox and infectious mononucleosis. Bacterial infections are rare and mostly secondary to the viral infections. In infants oral candidiasis (thrush) is a common cause of stomatitis. Most infections are self-limiting and reassurance of parents is important. Dehydration is a common complication and admission to hospital can be prevented by analgesics. The most important non-infectious conditions that cause stomatitis in children are recurrent aphthous stomatitis, erythema multiforme major (Stevens-Johnson syndrome), Behçet's disease, malignancy (leukaemia), immune-mediated disorders (agranulocytosis, cyclic neutropenia), traumata, blistering disorders of the skin and lichen planus. A complete history and a thorough physical examination usually give the correct diagnosis and further investigations are seldom necessary.
Nederlands tijdschrift voor geneeskunde 11/2000; 144(42):1985-90.
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Nederlands tijdschrift voor geneeskunde 11/1995; 139(40):2017-20.
