html5-img
1 / 23

CASE REPORT

CASE REPORT. Dr Veselinka Djurisic Institute for Children ’s Disease s Montenegro. Female infant, 8 month old; Admitted to hospital due to: Diarrhoea ; Metabolic disbalance; With sings of enteropathy. . History of Present Illness.

lynch
Télécharger la présentation

CASE REPORT

An Image/Link below is provided (as is) to download presentation Download Policy: Content on the Website is provided to you AS IS for your information and personal use and may not be sold / licensed / shared on other websites without getting consent from its author. Content is provided to you AS IS for your information and personal use only. Download presentation by click this link. While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server. During download, if you can't get a presentation, the file might be deleted by the publisher.

E N D

Presentation Transcript

  1. CASE REPORT Dr VeselinkaDjurisic Institute for Children’s Diseases Montenegro

  2. Female infant, 8 month old; • Admitted to hospital due to: • Diarrhoea; • Metabolic disbalance; • With sings of enteropathy.

  3. History of Present Illness • 15 min before admission to hospital present with sudden abdominal cramping, cyanosis of limbs, she was lethargic, with drooping head. • Day before admision, she was sleepless, agitated, inconolably crying, with non bilious, non-projectile vomiting (4 times/day), and she had 10 regular stools. • 9 days before she was addmited to hospital due to vomiting, diarrhoea and high fever.

  4. Personal hystory: • Third child from regular pragnancy and term delivery completed with caesarean section. • Birth weight: 2830 g; Birth length: 53 cm; AS 9 • Breastfeeded 3 mo, after that continued adapted milk formula, 1 month later started mixed non-milk nutrition. • No history of allergy, regularly vaccinated

  5. Family history • Older brother – convulsions trated with AET; • Father – epilepsy; • Mother – chronic enteropathy in childhood suggested gluten free diet, but she refused; • Grandfather – COPD;

  6. Clinical finding • Weight 7 kg • Agitated, crying, groaning, dehydrated, afebrile (36,7⁰C), hemodynamically stable; • Vital sings: RR 36/min, CF 136/min, spO2 93%; • Skin: pale, marble, with limbs cyanosis. • Left torticollis, slight axial hypotonia. • Normal auscultatory findings of lungs and heart . • Abdominal examination: abdominal distension ,soft and nontender, without tumefacts and organomegaly.

  7. Laboratory findings

  8. Normal urin dipstick and sediment findings

  9. Tissue transglutaminase antibody: • IgG 269; • IgA > 300; • Anti – gliadin antibodies: • IgG 6 ; • IgA > 300;

  10. Microbiology • Stool culture, ova and parasite testing, Rotavirus and Adenovirus: NEGATIVE. • Stool: positive for Candida sp. • Urin culture: negative.

  11. Radiology findings • X-ray plain film • air-fluid levels

  12. Radiology findings • Ultrasound revealed mass suspected to intussusception in right hemiabdomen: • Target sign (also known as the doughnut sign) • Pseudokidney sign

  13. Radiology findings • Abdominal CT scan reveals dilated and fluid-filled loops of small bowel with air-fluid levelsthe classic ying-yang sign of an intussusceptum inside an intussuscipiens in right hemiabdomen.

  14. Rectoscopy was performed: reveal normal. • The lining of the colon appears smooth and pink, with numerous folds. • No abnormal growths, pouches, bleeding, or inflammation is present.

  15. COURSE • Treated with antibiotics: • metronidazole • gentamicin • Corticosteroids: • methylprednisolone • H2 blockers: • ranitidine • Transfusion of fresh frozen plasma, 3 times

  16. After exclusion of acute abdomen, cow protein free diet was introduced, but without any improvement. • Spontaneus desinvagination. • After obtainig coeliac serology, gluten free diet has started, occurs clinical improvement with metabolic stabilisation.

  17. Conclusion • Case of rare but serious clinical presentation of celiac crisis. • It is important to recognize that CD may present in “crisis.” • The possible precipitating factors in present patient are unrecognized coeliac disease, hypokalemia and previous infection.

  18. Discussion • Incidence of celiac disease is on rise in Montenegro. • Prevalence of CD is found to be........ dopuniti ukoliko postoje podaci..... • Celiac crisis is a life-threatening complication of CD. • Clinically, it is characterized by severe diarrhea, dehydration and metabolic disturbances like hypokalemia, hypomagnesemia, hypocalcemia, hypoproteinemia and metabolic acidosis.

  19. Definition of celiac crisis • Acute onset or rapid progression of gastrointestinal symptoms attributable to celiac disease requiring hospitalization and/or parenteral nutrition along with at least 2 of the following:

  20. Metabolic pathophysiology in celiac crisis

  21. Celiac crisis may not respond to a gluten-free diet alone. In severely ill children with celiac crisis, the use of corticosteroids may cause dramatic improvement. * • Lloyd-Still described 3 cases of celiac crisis successfully treated with corticosteroids. ** • The role of steroids now is controversial as gluten free and good nutritional diet are considered good enough to tide over the crisis *** * Mihailidi E, Paspalaki P, Katakis E, Evangeliou A. Celiac Disease: A Pediatric Perspective. International Pediatrics 2003;18:141-8. ** Lloyd-Still JD, Grand RJ, Khaw KT, Shwachman H. The use of corticosteroids in celiac crisis. J Pediatr. 1972; 81: 1074-1081. *** Walia A, Thapa BR. Celiac crisis. Indian Pediatr. 2005; 42: 1169

  22. Grazie per l'attenzione Saluti da Montenegro

More Related