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Salah S, Alshanbari SN, Masmali HM. A term infant with severe hypereosinophilia secondary to CMV infection and the STAT1 gene mutation: a case report : List of authors. BMC Pediatr 2024; 24:408. [PMID: 38918745 PMCID: PMC11200823 DOI: 10.1186/s12887-024-04846-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/28/2024] [Accepted: 05/21/2024] [Indexed: 06/27/2024] Open
Abstract
Hypereosinophilia is a rare presentation in all age groups, particularly when it is severe, persistent, and progressive. We describe the clinical characteristics and course of severe hypereosinophilia in a full-term Saudi female neonate. A febrile respiratory illness evolved with a progressive increase in peripheral blood leukocyte and eosinophil counts, reaching 44.9% of leukocytes and an absolute value of 57,000 cells/µl. Different etiological examinations (for viral, bacterial, immunodeficiency, hyper IgE syndrome, gene mutations) revealed extremely high CMV antigenemia and a homozygous mutation in the STAT1 gene. Anhelation was relieved by oxygen and anti-viral treatment. Steroids brought a dramatic response in peripheral blood counts within 24 h. After a 6-week course of antiviral and steroid treatment at home, she had an excellent general condition. Conclusion: Although a rare pathology, it is important to consider genetic disorders when there is an atypical immune response to viral infections.
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Affiliation(s)
- Shaimaa Salah
- Pediatric Department, Faculty of Medicine, Kafrelsheikh University, Kafr El-Shaikh, Egypt.
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Delteil C, Tuchtan L, Torrents J, Capuani C, Piercecchi-Marti MD. Pediatric medicolegal autopsy in France: A forensic histopathological approach. J Forensic Leg Med 2017; 53:106-111. [PMID: 29232618 DOI: 10.1016/j.jflm.2017.11.010] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2017] [Revised: 11/16/2017] [Accepted: 11/27/2017] [Indexed: 10/18/2022]
Abstract
The aim of postmortem medicolegal examination in pediatric death is primarily to establish the circumstances and causes of death and to exclude child abuse. In France, pediatric death is systematically documented by medicolegal or medical autopsy. In case of medicolegal autopsy, the complementary examinations, requested and financed by justice, are rarely limited to a histopathological examination. However in medical autopsies other tools are available to the pathologist as toxicology, biochemistry and molecular biology. The purpose of this article is to evaluate the efficacy of forensic histopathology in pediatric forensic autopsies. We analyze the main causes of pediatric death in a forensic context. Between 2004 and 2015, 157 infant deaths were identified in Marseille university hospital. The forensic histopathology and autopsy reports of all 157 cases were available for systematic review. Medical or surgical causes represented 41,3% of deaths in our center, accidental causes 8.1% and child abuse 28,8%. The definitive diagnosis was made at autopsy in 30% of cases and at histopathological examination in 70% highlighting that forensic histopathology is an indispensable tool in pediatric medicolegal autopsies. Significant histological abnormalities may be detected in selected organs such as the brain, lungs, heart, liver, adrenal glands and kidneys in spite of macroscopically normal appearances. This justifies systematic sampling of all organs. Despite the implementation of the French sudden infant death protocol which recommends medical autopsies, too many pediatric autopsies are carried out in a medicolegal context. 30% of the cases remain without diagnosis at the end of the autopsy and histological examination. This number could be reduced by the contribution of others laboratory investigation.
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Affiliation(s)
- Clémence Delteil
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France.
| | - Lucile Tuchtan
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Julia Torrents
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France
| | - Caroline Capuani
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
| | - Marie-Dominique Piercecchi-Marti
- Institut Médico-Légal, Hôpital de la Timone, 264 rue St-Pierre, 13005 Marseille Cedex 5, France; Aix Marseille Univ, CNRS, EFS, ADES, Marseille, France
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McEachern W, Godown J, Dodd DA, Dipchand AI, Conway JL, Wilson GJ, Hoffman RD. Sudden death in a pediatric heart transplant recipient with peripheral eosinophilia and eosinophilic myocardial infiltrates. Pediatr Transplant 2017; 21. [PMID: 28504342 DOI: 10.1111/petr.12937] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/30/2017] [Indexed: 11/26/2022]
Abstract
Eosinophilia has been rarely reported in pediatric heart transplant recipients and has been suggested to play a role in graft rejection. We report a case of a young female patient with peripheral blood eosinophilia who died suddenly 2 years following ABO-incompatible heart transplantation. She was found at autopsy to have myocardial infiltration of not only T-lymphocytes and macrophages expected in acute cellular rejection but also of eosinophils, B-lymphocytes, and plasma cells indicating myocarditis.
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Affiliation(s)
- William McEachern
- Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Justin Godown
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Debra A Dodd
- Division of Pediatric Cardiology, Monroe Carell Jr. Children's Hospital at Vanderbilt, Nashville, TN, USA
| | - Anne I Dipchand
- Department of Pediatrics, Labatt Family Heart Centre, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Jennifer L Conway
- University of Alberta, Stollery Children's Hospital, Edmonton, AB, Canada
| | - Gregory J Wilson
- Division of Pathology, University of Toronto, The Hospital for Sick Children, Toronto, ON, Canada
| | - Robert D Hoffman
- Department of Pathology, Microbiology, and Immunology, Vanderbilt University School of Medicine, Nashville, TN, USA
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Papneja K, Chan AK, Mondal TK, Paes B. Myocardial Infarction in Neonates: A Review of an Entity with Significant Morbidity and Mortality. Pediatr Cardiol 2017; 38:427-441. [PMID: 28238152 DOI: 10.1007/s00246-016-1556-7] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2016] [Accepted: 12/23/2016] [Indexed: 01/24/2023]
Abstract
Coronary artery disease is a global problem with high mortality rates and significant residual sequelae that affect long-term quality of life. Myocardial infarction (MI) in neonates is a recognized, uncommon entity, but the incidence and broad spectrum of the disease is unknown and likely underestimated due to limited reporting which in the majority is confined to acute ischemic events. The challenges involve clinical diagnosis which masquerades in the early phase as non-specific symptoms and signs that are commonly found in a host of neonatal disorders. Precise diagnostic criteria for neonatal MI are lacking, and management is driven by clinical presentation and hemodynamic stabilization rather than an attempt to rapidly establish the root cause of the condition. We conducted a review of the published reports of neonatal MI from 2000 to 2014, to establish an approach to the diagnosis and management based on the existing evidence. The overall evidence from 32 scientific articles stemmed from case reports and case series which were graded as low-to-very low quality. Neonatal MI resembles childhood and adult MI with features that involve characteristic ECG changes, raised biomarkers, and diagnostic imaging, but with lack of robust, standardized criteria to facilitate prompt diagnosis and timely intervention. The mortality rate of neonatal MI ranges from 40 to 50% based on inclusion criteria, but the short-term data reflect normal quality of life in survivors. An algorithm for the diagnosis and management of neonatal MI may optimize outcomes, but at the present time is based on limited evidence. Well-designed clinical studies focusing on the definition, diagnosis, and management of neonatal MI, backed by international consensus guidelines, are needed to alter the prognosis of this serious condition.
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Affiliation(s)
- Koyelle Papneja
- Division of Pediatrics, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Anthony K Chan
- Division of Pediatric Hematology/Oncology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Tapas K Mondal
- Division of Cardiology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada
| | - Bosco Paes
- Division of Neonatology, McMaster Children's Hospital, McMaster University, Hamilton, ON, Canada. .,Department of Pediatrics, McMaster University, Room HSC-3A, 1280 Main Street West, Hamilton, ON, L8S 4K1, Canada.
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Pollock AJ, Hitt SL, Stier MA, Houser LM. Eosinophilic Endomyocarditis: A Rare Case of Neonatal Mortality. AJP Rep 2015; 5:e150-2. [PMID: 26495174 PMCID: PMC4603850 DOI: 10.1055/s-0035-1552929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/29/2014] [Accepted: 03/26/2015] [Indexed: 10/31/2022] Open
Abstract
Background Eosinophilic endomyocarditis (EEM) is a rare diagnosis that is extremely uncommon in newborns. This case report aimed to present a case of neonatal mortality from acute cardiac failure due to EEM. Case Our report presents a term male neonate with minor complications in the immediate postnatal course, who was discharged at 48 hours of life, but who developed unexpected respiratory distress, followed by cardiac arrest and death at 3 days of life. One day after discharge, the infant developed respiratory distress and cool skin, and then developed cardiac arrest at the pediatrician's office, undergoing resuscitation with intravenous fluid, cardiopulmonary resuscitation, epinephrine, atropine, and failed intubation. Autopsy revealed EEM, an inflammatory infiltrative process involving the endomyocardium. Pathology Pathogenesis involves three stages: (1) myocarditis with an acute eosinophilic inflammatory infiltrate followed by (2) myocyte necrosis and eventually (3) fibrosis in the final stage of the disease. Discussion The cause of death was acute cardiac failure due to intense eosinophilic infiltration and degranulation with early subendocardial myocyte necrosis but before development of extensive myocyte necrosis. This case appears to be the youngest patient reported with EEM.
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Affiliation(s)
- Allison J Pollock
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Stacy L Hitt
- Department of Pathology, Children's Hospital of Wisconsin, Milwaukee, Wisconsin
| | - Michael A Stier
- Department of Pathology, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
| | - Laura M Houser
- Department of Pediatrics, University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin
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Eosinophilic cardiac disease: Molecular, clinical and imaging aspects. Arch Cardiovasc Dis 2015; 108:258-68. [DOI: 10.1016/j.acvd.2015.01.006] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/10/2014] [Revised: 01/13/2015] [Accepted: 01/13/2015] [Indexed: 01/21/2023]
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A fatal case with eosinophilia after pediatric heart transplantation. J Heart Lung Transplant 2011; 30:596-9. [DOI: 10.1016/j.healun.2011.01.713] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2010] [Revised: 01/21/2011] [Accepted: 01/21/2011] [Indexed: 11/23/2022] Open
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Bhogal N, Grady AM, Ursell PC, Collins KK, Hornberger LK. Hypersensitivity Myocarditis Presenting as Atrioventricular Block and Wide Complex Tachycardia in a Toddler. CONGENIT HEART DIS 2008; 3:359-64. [DOI: 10.1111/j.1747-0803.2008.00185.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
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