[Show abstract][Hide abstract] ABSTRACT: Molluscum contagiosum is an infectious disease presenting with flesh-colored, dome-shaped, umblicated papules. A few atypical presentations have been reported in immunodeficient patients. A 5-year-old boy with acute lymphoblastic leukemia, presented with bright white-colored papular lesions with no umblications on the chin during his continuation chemotherapy. Increased number of the lesions covered almost his entire chin in months. Topical therapies did not improve the lesions. After his bone marrow relapse, induction chemotherapy was withheld because of bronchopneumonia after febrile neutropenia. After initiation of a combination of systemic parenteral antibiotic and antifungal therapies, his parents squeezed one of his papular lesions. Meanwhile, systemic acyclovir was added to his therapy, because of herpes labialis. Despite the large spectrum of his therapies, in 1.5 months, this small lesion progressed to a large lesion with erythematous ground and a central ulceration. Etiology of the lesion could not be enlightened until a skin biopsy that was compatible with the molluscum contagiosum. A partial resolution was achieved by cryotherapy. In conclusion, molluscum contagiosum may present as an ulcerating lesion during childhood leukemia treatment. A skin biopsy should be performed for the accurate diagnosis of atypical cutaneous lesions in immunocompromised patients.
No preview · Article · Mar 2011 · Journal of Pediatric Hematology/Oncology
[Show abstract][Hide abstract] ABSTRACT: The objectives of this study was to investigate of the influences of high-dose (20 mg/kg/day) methyl prednisolone (HDMP) and granulocyte colony stimulating factor (G-CSF) in shortening the duration of chemotherapy-induced neutropenia encountered in children with ALL receiving maintenance therapy. Sixty-four non-febrile neutropenic attacks developed in 29 patients with ALL receiving St Jude XIII maintenance protocol were evaluated retrospectively. The patients were clinically followed up without drugs for shortening the duration of neutropenia in 21 (32.8%) attacs, while HDMP and G-CSF were administered in 26 (40.6%) and 17 (26.6%) attacks, respectively. After the detection of neutropenia, restoration of neutrophil counts at 2nd or 4th days to the levels that allow resuming the chemotherapy were considered as success. While second day and overall success rates in patients administered HDMP and G-CSF were significantly higher than the patients who were observed clinically. Both second day and overall neutrophil counts were significantly higher in patients administered G-CSF than the other groups. Methyl prednisolone and G-CSF treatments were well-tolerated by the patients. The cost-per neutropenic attack was significantly higher in G-CSF group than of the HDMP group. Especially in patients experiencing frequent neutropenic attacks and hence interruptions of the therapy, one of the myelopoiesis induction therapies can be used to shorten the duration of neutropenia. For this indication short-course HDMP therapy can be considered as an alternative to G-CSF in this patients due to its relatively low cost, amenability to outpatient administration, and well-tolerability by children.
No preview · Article · Mar 2011 · Fundamental and Clinical Pharmacology
[Show abstract][Hide abstract] ABSTRACT: Malignant infantile osteopetrosis presents in the first months of life with hepatosplenomegaly, anemia, thrombocytopenia, optic atrophy, and deafness. It may rarely present with rickets. Here, we present a boy who had osteopetrosis coexisting with rickets. A four-month-old boy was consulted to our clinic due to hepatosplenomegaly. He was the first child of consanguineous parents. He was diagnosed as rickets at the age of 2.5 months. Laboratory investigation revealed anemia, leukocytosis and thrombocytopenia, as well as hypocalcemia (5.4 mg/dl), phosphorus 4.2 mg/dl, and increased alkaline phosphatase (1411 IU/L). Parathormone level was high (112 pg/ml), and urine Ca/Cre was low (0.07). Bone X-rays revealed generalized increased bone density and widening and cupping of the distal epiphyses of the radius and ulna. The findings were compatible with osteopetrosis and rickets. Vitamin D (2000 IU/d po) was given for a one-week period with calcium gluconate, and then 400 IU vitamin D was continued daily. In conclusion, rickets may be the first finding in osteopetrosis. We suggest that physicians should give effort to determine if rickets is present in a baby with osteopetrosis, and if a baby with rickets is unresponsive to appropriate therapy or rickets is recurrent, the differential diagnosis should include osteopetrosis.
No preview · Article · Jan 2009 · Cocuk Sagligi ve Hastaliklari Dergisi
[Show abstract][Hide abstract] ABSTRACT: Vincristine is a commonly used antineoplastic drug and frequently causes neurotoxicity. Here the authors report a 4-year-old boy with acute lymphoblastic leukemia in whom vincristine-induced peripheral and cranial neuropathy developed during remission induction therapy. The patient seemed to benefit from pyridoxine and pyridostigmine therapy greatly and this therapy is recommended in patients with severe vincristine-induced neuropathy.
No preview · Article · Oct 2007 · Pediatric Hematology and Oncology
[Show abstract][Hide abstract] ABSTRACT: A 5-year-old girl in whom the diagnosis of inherited factor XIII deficiency was established at the age of 1 day presented with cryptic tonsillitis along with drowsiness and an abrupt occurrence of getting left interior cross eyed. While an intracranial hemorrhage was expected, cerebral imaging studies surprisingly revealed multiple sino venous thrombosis. In prothrombotic screening studies she and her father were both found to be heterozygous for factor V Leiden mutation along with having elevated levels of lipoprotein(a). Low-molecular-weight heparin was started. Ventriculoperitoneal shunt was applied because of persistence of increased intracranial pressure. Thrombosis disappeared and blood flow was normalized by the end of 2 months and the patient was discharged on coumadin therapy as being well. We would like to report this unusual case and to discuss the possible effects of two major genetic prothrombotic risk factors on inherited bleeding tendency or vice versa.
No preview · Article · Jul 2007 · Blood Coagulation and Fibrinolysis
[Show abstract][Hide abstract] ABSTRACT: Vitamin B12 has important functions in cell cycle and it is essential for DNA synthesis and it plays a part in myelinisation and lipid metabolism of nervous system. Infantile nutritional megaloblastic anemia occurs due to both maternal and infantile causes. In here we presented three infants with megaloblastic anemia and who have different neurologic findings. Vitamin B12 deficiency causes different signs and symptoms but, the question that how much depth and length of vitamin B12 deficiency causes neurologic findings is not answered. We presented three infants with megaloblastic anemia caused by maternal and/or infantile causes and we want to emphasize neurologic manifestations. We observed that neurologic signs are independent from VB12 level. In a conclusion further animal experiments which explain the correlation between megaloblastic anemia and neurologic manifestations are needed.
No preview · Article · Jan 2005 · Ondokuz Mayis Universitesi Tip Dergisi
[Show abstract][Hide abstract] ABSTRACT: A 2-month-old boy was presented with fever and restlessness. He was the third child of consanguineous parents and born after a full-term uncomplicated pregnancy. His older brother had been diagnosed as osteopetrosis and died when he was 2 years old. In laboratory findings his hemoglobin was 6.3 gr/dL, white blood count 4150/mm3, platelet count 120.000/mm3, calcium level was 6.1 mg/dL, phosphorus 2.9 mg/dL and alkaline phosphatase 1398 IU/L. Parathormone level was high (295 pg/mL), urine Ca/cre (0.2) was significantly decreased with normal 25 hydroxyvitamin D level. Examinatin of bones revealed generalized increased bone density, cupping of the distal epiphyses in the radius and ulnae. Radiographic and laboratory findings were compatible with osteopetrosis and rickets. He had seizure because of hypocalcemia. 2000 IU (low dose) vitamin D was given for one week period with parenteral calcium gluconat (100 mg/kg/dose) and thereafter 400 IU vitamin D was continued daily. After treatment of low dose-short period vitamin D, hypocalcemia improved, and secondary calcification was shown in ulnae by X-Ray.
No preview · Article · Jan 2004 · Ondokuz Mayis Universitesi Tip Dergisi
[Show abstract][Hide abstract] ABSTRACT: Celiac disease is an enteropathy that goes with small intestine mucosal damage in a sensitive person consuming gluten-containing diet. The disease has a wide spectrum of symptoms. In general it presents with chronic diarrhea, abdominal pain, fatigue, weakness, abdominal distention and failure to thrive but patients may refer with a single symptom. Familial Mediterranean Fever (FMF) is a disease that causes chronic abdominal pain. A 13 year-old patient who was suffering from chronic abdominal pain is reported here. At first he was diagnosed as FMF and colchicine treatment was started. Later on, due to treatment failure he was evaluated again and celiac disease was investigated because short stature was noticed in addition to abdominal pain. As the serologic and histopathologic findings supported celiac disease, gluten free diet was started. The symptoms disappeared completely after the gluten free diet. Six months later the patient gained weight and height and the measured serum celiac antibodies became negative. In conclusion, celiac disease should be kept in mind in patients with chronic abdominal pain.
No preview · Article · Jan 2003 · Ondokuz Mayis Universitesi Tip Dergisi