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Stevens JP, Dakshinamoorthy J, Gill AE, Parker P, Geem D, Berauer JP, Schoen B, Gupta N, Romero R. Undiagnosed Metachromatic Leukodystrophy Presenting as Severe Gastrointestinal Bleeding and Cholestasis from Hemobilia. JPGN Rep 2021; 2:e122. [PMID: 37206461 PMCID: PMC10191546 DOI: 10.1097/pg9.0000000000000122] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/01/2020] [Accepted: 05/20/2021] [Indexed: 05/21/2023]
Abstract
Metachromatic leukodystrophy (MLD) is a neurodegenerative disorder caused by the accumulation of lipids called sulfatides throughout the nervous system. Sulfatides can also collect in other organs throughout the body including the gallbladder where they form polyps. Gallbladder polyps rarely have been found to bleed in patients with known MLD, presumably due to polyp shearing. Here we present a case of a child with autism presenting with severe gastrointestinal bleeding and direct hyperbilirubinemia, requiring significant resuscitation and biliary drain placement to tamponade ongoing bleeding. Subsequent neurologic and genetic investigation led to the diagnosis of MLD, with laparoscopic cholecystectomy revealing extensive, elongated gallbladder polyps. Clinicians who care for patients with MLD, including gastroenterologists who manage their progressive oropharyngeal dysphagia, should be aware of the risk for this life-threatening complication. Moreover, pediatric gastroenterologists and hepatologists should maintain a high index of suspicion for MLD in new patients presenting with developmental regression and gastrointestinal bleeding.
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Affiliation(s)
- James P. Stevens
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | | | - Anne Elizabeth Gill
- Department of Radiology & Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Emory University School of Medicine, Atlanta, GA
| | - Paul Parker
- Division of Pediatric Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Duke Geem
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - John-Paul Berauer
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Bess Schoen
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Nitika Gupta
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
| | - Rene Romero
- From the Division of Gastroenterology, Hepatology, and Nutrition, Children’s Healthcare of Atlanta, Atlanta, GA
- Department of Pediatrics, Emory University School of Medicine, Atlanta, GA
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Gupta N, Liu C, King E, Sylvester F, Lee D, Boyle B, Trauernicht A, Chen S, Colletti R, Ali SA, Al-Nimr A, Ayers TD, Baron HI, Beasley GL, Benkov KJ, Cabrera JM, Cho-Dorado ME, Dancel LD, Di Palma JS, Dorsey JM, Gulati AS, Hellmann JA, Higuchi LM, Hoffenberg E, Israel EJ, Jester TW, Kiparissi F, Konikoff MR, Leibowitz I, Maheshwari A, Moulton DE, Moses J, Ogunmola NA, Palmadottir JG, Pandey A, Pappa HM, Pashankar DS, Pasternak BA, Patel AS, Quiros JA, Rountree CB, Samson CM, Sandberg KC, Schoen B, Steiner SJ, Stephens MC, Sudel B, Sullivan JS, Suskind DL, Tomer G, Tung J, Verstraete SG. Continued Statural Growth in Older Adolescents and Young Adults With Crohn's Disease and Ulcerative Colitis Beyond the Time of Expected Growth Plate Closure. Inflamm Bowel Dis 2020; 26:1880-1889. [PMID: 31968095 DOI: 10.1093/ibd/izz334] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2019] [Indexed: 02/06/2023]
Abstract
BACKGROUND Cessation of statural growth occurs with radiographic closure of the growth plates, radiographically defined as bone age (BA) 15 years in females and 17 in males. METHODS We determined the frequency of continued growth and compared the total height gain beyond the time of expected growth plate closure and the chronological age at achievement of final adult height in Crohn's disease (CD) vs ulcerative colitis (UC) and described height velocity curves in inflammatory bowel disease (IBD) compared with children in the National Health and Nutrition Examination Survey (NHANES). We identified all females older than chronological age (CA) 15 years and males older than CA 17 years with CD or UC in the ImproveCareNow registry who had height documented at ≥3 visits ≥6 months apart. RESULTS Three thousand seven patients (48% female; 76% CD) qualified. Of these patients, 80% manifested continued growth, more commonly in CD (81%) than UC (75%; P = 0.0002) and in females with CD (83%) than males with CD (79%; P = 0.012). Median height gain was greater in males with CD (1.6 cm) than in males with UC (1.3 cm; P = 0.0004), and in females with CD (1.8 cm) than in females with UC (1.5 cm; P = 0.025). Height velocity curves were shifted to the right in patients with IBD vs NHANES. CONCLUSIONS Pediatric patients with IBD frequently continue to grow beyond the time of expected growth plate closure. Unexpectedly, a high proportion of patients with UC exhibited continued growth, indicating delayed BA is also common in UC. Growth, a dynamic marker of disease status, requires continued monitoring even after patients transition from pediatric to adult care.
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Affiliation(s)
- Neera Gupta
- Department of Pediatrics, Weill Cornell Medicine, New York, NY, USA
| | - Chunyan Liu
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Eileen King
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, OH, USA
| | - Francisco Sylvester
- Division of Pediatric Gastroenterology, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Dale Lee
- Department of Pediatrics, Seattle Children's Hospital, Seattle, WA, USA
| | - Brendan Boyle
- Division of Gastroenterology, Hepatology and Nutrition, The Ohio State University College of Medicine, Columbus, OH, USA
| | - Anna Trauernicht
- Division of Pediatric Gastroenterology, Boys Town National Research Hospital, Boys Town, NE, USA
| | - Shiran Chen
- Division of Biostatistics and Epidemiology, Cincinnati Children's Hospital Medical Center, Cincinnati, OH, USA
| | - Richard Colletti
- Department of Pediatrics, University of Vermont College of Medicine, Burlington, VT, USA
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Mossoba MM, Chizhikov V, Volokhov DV, Martinez-Diaz Milians K, Schoen B, Al-Khaldi SF. Identification of Mycoplasmas using a fluorophore-free microarray and infrared chemical imaging (IRCI). J Microbiol Methods 2011; 86:383-6. [PMID: 21693139 DOI: 10.1016/j.mimet.2011.06.003] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2011] [Revised: 06/01/2011] [Accepted: 06/06/2011] [Indexed: 11/18/2022]
Abstract
A novel application of mid-infrared chemical imaging (IRCI) for the fluorophore-free detection and identification of mycoplasma species is reported for the first time. The PCR-amplified biotinylated targets hybridized to microarray probes were treated with streptavidin-gold nanoparticles followed by silver enhancement. This modification has the potential to expand the implementation of DNA microarray techniques in laboratories involved in the detection of cell substrates, other biological products, and clinical materials for the presence of mycoplasmas.
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Affiliation(s)
- M M Mossoba
- Food and Drug Administration, Center for Food Safety and Applied Nutrition, 5100 Paint Branch Parkway, College Park, MD 20740-3835, USA.
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Berkowitz FE, Henderson SL, Fajman N, Schoen B, Naughton M. Acute liver failure caused by isoniazid in a child receiving carbamazepine. Int J Tuberc Lung Dis 1998; 2:603-6. [PMID: 9661830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
We report a case of a 10-year-old boy, being treated for seizures with carbamazepine, who developed acute liver failure within four days of initiation of therapy for suspected tuberculosis with isoniazid, rifampin, pyrazinamide, and ethambutol. Isoniazid-induced liver disease was diagnosed. The likely role of carbamazepine and rifampin in potentiating the hepatotoxicity of isoniazid, and the importance of early recognition of isoniazid-induced liver disease, are discussed.
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Affiliation(s)
- F E Berkowitz
- Department of Pediatrics, Emory University School of Medicine, and Pharmacy, Egleston Children's Hospital, Atlanta, Georgia 30303, USA
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