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The Committee on Infectious Diseases of the American Academy of Pediatrics, and the Advisory Committee on Immunization Practices of the Center for Disease Control for many years have recommended the routine use of influenza vaccine in various hemoglobinopathies including sickle cell disease. This recommendation, however, has not been included in the patient care protocols of the Comprehensive Sickle Cell Centers program of NIHLB. Most clinicians have not used yearly influenza vaccine for their patients with sickle cell disease. This article reports a case of a 5-year-old boy with sickle cell disease who had not received influenza vaccine. He developed pneumonitis and acute myositis during a serologically confirmed influenza B virus infection. The incapacitating and protracted course of his illness presented diagnostic and management problems. His case strongly supports the recommendation of the two infectious disease committees.

Enterobacter species, in recent years, have been divided into E aerogenes, E hafniae, E liquefaciens, and E cloacae. Early reviews of neonatal meningitis include some cases due to Klebsiella-Aerobacter,(1) and recent reviews(2,3) include Enterobacter which did not divide them into species of Enterobacter. Reported here is a case of neonatal meningitis due to a gram-negative organism, Enterobacter cloacae.

A 10½-year-old boy with an IQ of 71, short stature, and isolated growth hormone deficiency was found to have diploid/tetraploid mosaicism. He was born to a 46xx/47xxx mosaic mother. The mother was found to be moderately mentally retarded but showed no other abnormalities. A review of literature pertinent to this case is presented.

A 10-year-old girl initially presented with clinical features and thyroid function tests consistent with hyperthyroidism. She was treated with propylthiouracil, 100 mg, three times a day. She developed jaundice and hepatitis following treatment with propylthiouracil for 40 days. Clinical features of hepatitis improved after the discontinuation of propylthiouracil and she became euthyroid. At this time, an immunofluorescent technique revealed antibodies consistent with autoimmune thyroiditis. From this report, it appears that hepatitis is one of the infrequent complications of treatment with propylthiouracil and transient hyperthyroidism may be associated with autoimmune thyroiditis.

Endocrine disorders associated with mental retardation are described in relation to clinical characteristics, pathogenesis, diagnostic procedures, and treatment. Some endocrine disorders, particularly hypothyroidism, nephrogenic-diabetes insipidus, and hypoglycemic conditions, are frequently associated with mental retardation. Early diagnosis and prompt and proper management reduce mortality and the incidence of mental retardation associated with endocrine disorders.

Nineteen patients, nine males and ten females had 24 episodes of diabetic ketoacidosis. Infection was the precipitating factor in the development of ketoacidosis. Recovery of ketoacidosis occurred with 0.7 units of crystalline insulin per kg of body weight. The insulin requirement is less than the generally recommended dose. Hypoglycemia, hypokalemia, and alkalosis were not developed in our children. Ketoacidosis was adequately corrected by 2.5 mEq of sodium bicarbonate per kg of body weight.