Case report
This presentation is the property of its rightful owner.
Sponsored Links
1 / 23

CASE REPORT PowerPoint PPT Presentation


  • 72 Views
  • Uploaded on
  • Presentation posted in: General

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.

Download Presentation

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.While downloading, if for some reason you are not able to download a presentation, the publisher may have deleted the file from their server.


- - - - - - - - - - - - - - - - - - - - - - - - - - E N D - - - - - - - - - - - - - - - - - - - - - - - - - -

Presentation Transcript


Case report

CASE REPORT

Dr VeselinkaDjurisic

Institute for Children’s Diseases

Montenegro


Case report

  • Female infant, 8 month old;

  • Admitted to hospital due to:

    • Diarrhoea;

    • Metabolic disbalance;

    • With sings of enteropathy.


History of present illness

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.


Personal hystory

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


Family history

Family history

  • Older brother – convulsions trated with AET;

  • Father – epilepsy;

  • Mother – chronic enteropathy in childhood suggested gluten free diet, but she refused;

  • Grandfather – COPD;


Clinical finding

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.


L aboratory findings

Laboratory findings


Case report

Normal urin dipstick and sediment findings


Case report

  • Tissue transglutaminase antibody:

    • IgG 269;

    • IgA > 300;

  • Anti – gliadin antibodies:

    • IgG 6 ;

    • IgA > 300;


Microbiology

Microbiology

  • Stool culture, ova and parasite testing, Rotavirus and Adenovirus: NEGATIVE.

  • Stool: positive for Candida sp.

  • Urin culture: negative.


Radiology findings

Radiology findings

  • X-ray plain film

  • air-fluid levels


Radiology findings1

Radiology findings

  • Ultrasound revealed mass suspected to intussusception in right hemiabdomen:

    • Target sign (also known as the doughnut sign)

    • Pseudokidney sign


Radiology findings2

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.


Case report

  • 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.


Course

COURSE

  • Treated with antibiotics:

    • metronidazole

    • gentamicin

  • Corticosteroids:

    • methylprednisolone

  • H2 blockers:

    • ranitidine

  • Transfusion of fresh frozen plasma, 3 times


Case report

  • 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.


Conclusion

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.


Discussion

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.


Definition of celiac crisis

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:


Metabolic pathophysiology in celiac crisis

Metabolic pathophysiology in celiac crisis


Case report

  • 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


G razie per l attenzione

Grazie per l'attenzione

Saluti da Montenegro


  • Login