[Paravertebral pyomyositis in childhood following closed injury]

Pyomyositis is an acute bacterial infection that affects striated muscle and is generally accompanied by the formation of an abscess. In most cases, the microorganism involved is Staphylococcus aureus. Clinical findings are characterized by pain, swelling and muscular edema, together with variable general symptoms. Complications include arthritis, osteomyelitis and even septic shock with a mortality of 1.8%. We report the case of an 8-year-old boy who sustained a closed lumbar injury on banging his shoulder while he was playing on a trampoline and who developed paravertebral pyomyositis complicated by sepsis. S. aureus was isolated in the blood culture. The boy subsequently developed a perivertebral abscess and finally contiguous osteomyelitis in the L3 spinous process. The patient received treatment with vancomycin and metronidazole for 6 weeks followed by cloxacillin therapy for 2 weeks (a total of 8 weeks of intravenous antibiotic therapy). Physical examination 3 months after discharge revealed no abnormalities. The possibility of pyomyositis should be borne in mind, especially in children with fever, localized muscular pain and a history of accidental or sports injuries. Early diagnosis and treatment are important to reduce the risk of possibly fatal complications.

[Hypotonia and lethargy: initial manifestations of a new case of galactosemia]

INTRODUCTION

Galactosemia is a metabolic disease that is transmitted by autosomal recessive inheritance in which there is an enzymatic deficit that prevents the metabolism of galactose. Three enzymes could be involved, but the lack of galactose-1-phosphate uridyltransferase (GALT) is the most frequent. Incidence is two cases per 100,000 newborn infants. As a consequence of this enzymatic deficit, on ingesting milk the newborn infant will present a progressive neurological deterioration, cataracts and digestive tract and kidney disorders. An early diagnosis is essential so that galactose can be withdrawn from the diet as soon as possible, which in the newborn infant means discontinuing mother's milk and feeding with galactose-free milk.

CASE REPORT

We report the case of a newborn female, the daughter of consanguineous parents (second cousins) from the gypsy ethnic group, who was diagnosed as suffering from galactosemia with a total GALT deficit. The patient was given normal milk for the first 10 days of her life and presented hypotonia, lethargy, jaundice, hepatomegaly, refusal to eat, low weight gain and a urinary infection caused by gram negative bacteria. Following diagnosis, galactose was withdrawn from the diet (she was given soy milk) and the physical exploration became progressively more normal.

CONCLUSIONS

This is an extremely unusual pathology, but the patient's outcome is largely dependent on an early diagnosis and treatment.

[Meningitis due to Salmonella in the neonatal period]

INTRODUCTION

Meningitis due to Salmonella is an unusual sign of salmonellosis. Usually Salmonella causes clinical disorders of the digestive tract, but on occasions, especially in babies, may cause focalized infections such as meningitis. Although meningitis due to Salmonella is unusual, it should be remembered because of its gravity, since it has a high morbimortality. It mainly affects neonatal babies and those under 4 months of age. It usually precedes or is accompanied by gastroenteritis and has a rapid clinical course.

CLINICAL CASE

We present the case of a neonatal baby girl, 17 days old, who was very irritable, had liquid or semi-liquid faeces and high fever of unknown origin with poor response to antipyretic drugs. On lumbar puncture a cloudy liquid, compatible with bacterial meningitis was obtained. Treatment was therefore started immediately with intravenous ampicillin and cefotaxima. CSF culture grew Salmonella which was resistant to ampicillin but sensitive to cefotaxima. Antibiotic treatment was given for 21 days. There was excellent clinical recovery. After eight months of follow-up no sequelae have been seen and her development, both psychomotor, in height and in weight is normal for her age.

CONCLUSION

Meningitis due to Salmonella is an unusual condition. Immediate, suitable treatment is essential to obtain satisfactory recovery.

[Western type cerebro-muscular dystrophy and congenital merosin deficiency muscular dystrophy: two terms for the same disorder]

INTRODUCTION

Congenital muscular dystrophies (CMD) are a clinically heterogeneous group of muscular disorders characterized by hypotonia, muscle weakness and early or congenital joint contractures. Electromyography reveals a myopathic pattern, creatine-kinase (CK) may be moderately elevated and muscle biopsy shows pathological changes consistent with a dystrophic process.

OBJECTIVE

Report the cases of two brothers with 'Occidental type cerebro-muscular dystrophy' versus 'merosin-deficient CMD'.

PATIENTS AND METHODS

Two children, a boy and a girl, of a first consanguineous parents. In the first case, the diagnosis of Occidental type cerebro-muscular dystrophy was made in 1983, at the age of 4 years, according to clinical, biochemical, electromyographic, pathological and neuroradiological data. In the second case, the diagnosis of merosindeficient form of CMD was made with the same criteria and with immunohistochemistry and Western blot techniques in 1997, when she was 6 months old.

CONCLUSION

Occidental type cerebro-muscular dystrophy, described 13 years ago by one member of our group, corresponds with merosin-deficient form of CMD.

[Transdural anastomosis in a juvenile form of moyamoya disease]

INTRODUCTION

Moya-Moya disease has a low prevalence and world-wide distribution, with greater incidence in the first 5 years of life (juvenile form) or in the third decade (adult form). Stenosis of the intracranial portion of the internal carotid artery leads to secondary establishment of intracranial compensating anastamoses at different levels (leptomeninges, basal ganglia and transdural). We present the case of a 7 year old boy who presented clinically with choreiform movements and later had a cerebral infarct. On angio-MR and MR studies we observed the typical smoky image together with development of additional compensatory transdural anastomoses from the superficial temporal and ophthalmic arteries to the anterior and middle cerebral arteries.