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All-trans retinoic acid (ATRA), a derivative of vitamin A, has dramatically altered the treatment landscape for acute promyelocytic leukemia (APL). APL is characterized by the abnormal maturation of myeloid cells, which become arrested at the promyelocyte stage. ATRA effectively induces these cells to differentiate and undergo apoptosis. While generally well-tolerated, ATRA has been associated with rare adverse effects, including hypercalcemia. This case report underscores the importance of vigilant monitoring for ATRA-related side effects, especially when combined with medications which inhibit cytochrome P450 enzymes. Antifungal prophylaxis is common during leukemia treatment. Here, we present a rare instance of hypercalcemia in a pediatric patient attributed to the concurrent use of posaconazole and ATRA. A 15-year-old girl presented with widespread bruising, abnormal uterine bleeding, and pancytopenia. Subsequent investigations led to an APL diagnosis. Classified as standard-risk APL, she received chemotherapy according to the acute myelogenous leukemia-Berlin-Frankfurt-Münster 2004 protocol. After an ATRA course was started in the third month of maintenance treatment, she applied to the hospital with constitutional symptoms of weakness and fatigue on the third day of treatment. In the biochemical tests of the patient, serum Ca concentration was determined to be 16.5 mg/dL. Parathormone was 64.3 pg/mL and the 25-OH D vitamin level was 22 ng/mL and so were within the normal limits. Complete blood count was within the normal range. Although hypercalcemia is a side effect seen in the combined use of ATRA and azole antifungals, to the best of our knowledge, this is the first report in the literature that it was observed in the pediatric age group due to the simultaneous use of posaconazole and ATRA. [ABSTRACT FROM AUTHOR]

Background: Intravascular fasciitis (IF) is a benign, reactive, myofibroblastic proliferation that originates from the superficial or deep fascia of small / medium-sized arteries and veins. Case Report: An 8-year-old male patient was admitted to a health center with the complaint of swelling in the inguinal region. Lower extremity venous Doppler ultrasonography showed deep vein thrombosis (DVT) of the femoral vein and anticoagulation with low-molecular weight heparin (LMWH) was initiated. The patient was referred to our center for follow-up. The D-dimer level was detected within normal limits. Doppler ultrasonography was repeated and showed an intraluminal expanding mass lesion with increasing vascularity, without distinct borders and LMWH was discontinued. This lesion at the sapheno-femoral junction was excised surgically and the histopathological examination revealed intravascular fasciitis. Conclusion: Clinicians should be aware that the clinical findings of IF may mimic sarcoma and thrombosis. [ABSTRACT FROM AUTHOR]

Aim: To determine the risk factors associated with chronic childhood immune thrombocytopenia (ITP). Materials and Methods: We retrospectively analyzed the medical records of 123 children with ITP who were admitted to our Department of Pediatric Hematology between May, 2006 and May, 2019. We evaluated their demographic, clinical, and laboratory characteristics, and assessed the risk factors associated with chronic ITP in childhood. Results: Of the 123 children with ITP, 60.2% were male, with an average age of 6.4±4.0 years. At follow-up, 93 (75.6%) of the patients were diagnosed as acute ITP, whereas 30 (24.4%) progressed to chronic ITP with a platelet count of lower than 100x109/L at the end of the 12-month follow-up period. Older age at admission [Odds ratio (OR): 1.4, 95% confidence interval (CI): 1.2-1.6, p<0.001], female gender (OR: 4.1, 95% CI: 1.5-10.3, p=0.003), and insidious onset of the symptoms (OR: 5.0, 95% CI: 1.1-22.6, p=0.03) were determined to be risk factors for chronic ITP. Conclusion: Our study indicates that older age, female gender and insidious onset of the disease at admission may predict chronic ITP in childhood. [ABSTRACT FROM AUTHOR]

Hemoglobin (Hb) Hammersmith, formed by serine substitution for phenylalanine at residue 42 in the beta-globin chain, is a very rare variant of unstable hemoglobin with low oxygen affinity. For patients with hemoglobinopathies, it is well-established that hematopoietic stem cell transplantation provides a complete cure, but the literature on its role for those with Hb Hammersmith is limited. A seven-month-old girl who was examined for anemia and splenomegaly was followed up for congenital hemolytic anemia. The patient with visible cyanosis of the lips and whose p50 was low in blood gas was diagnosed with Hb Hammersmith through the DNA sequence analysis. During the follow-up, frequent blood transfusions had to be given due to anemia aggravated by infections. Following a successful hematopoietic stem cell transplant from an HLA-matched sibling, the patient completely recovered from Hb Hammersmith. The case is presented because of its rarity. [ABSTRACT FROM AUTHOR]

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Sweet syndrome is a rarely seen disease characterized with fever, arthralgia, neutrophilic leukocytosis and painful erythematous plaques, and dense neutrophilic inifltration in dermis at lesion sites which occur mostly on the face and upper extremities. A nine-year-old girl with a diagnosis of acute lymphoblastic leukemia was admitted to the hospital with high fever. Empirical broad spectrum antibiotic and granulocyte-colony stimulating factor (G-CSF) treatments were initiated for febrile neutropenia. Although antifungal therapy was added to the treatment during follow-up, hyperfebrile state could not be resolved. On the 14th day of G-CSF treatment, the result of the skin biopsy performed from red, painful eruptions seen on the legs was compatible with Sweet syndrome. G-CSF treatment was discontinued and intravenous steroids were started wit resultant control of fever, and resolution of the rash. Sweet syndrome should be kept in mind when erythematous rashes develop in patients with febrile neutropenia who have been using G-CSF for a long time and who have not been able to control their fever despite appropriate antibiotics and antifungals. [ABSTRACT FROM AUTHOR]

Transfusion-related acute lung injury (TRALI) is a non-cardiac pulmonary edema presenting with severe dyspnea, hypoxia and bilateral diffuse infiltrates on chest X-ray. It usually occurs within the first 6 hours following the administration of plasma and plasma rich blood products. Herein, we present a patient who developed TRALI shortly after plasmapheresis due to Hemolytic Uremic syndrome and exhibited a dramatic response with early systemic steroid treatment. [ABSTRACT FROM AUTHOR]

Eosinophilic gastroenteropathies are rare disorders. An 18-year-old girl presented to the hospital with abdominal pain and distension. Abdominal tenderness and grade 2 ascites, serious peripheral eosinophilia and high immunoglobulin E level were found. Laparoscopic antrum biopsy showed subserosal eosinophilic infiltration. Eosinophilic gastroenteropathy was suspected, diet elimination was given, no steroid treatment was used. [ABSTRACT FROM AUTHOR]

Invasive mucormycosis is a fungal infection that is rare but has a high mortality rate. It is often seen in immune supressed patients with diabetic ketoacidosis, hematologic malignancy, or those that have undergone stem cell transplantation. Febrile neutropenia, swelling of the right cheek, and a necrotic area in the palate developed during the induction chemotherapy of a three year-old male patient with acute lymphoblastic leukemia. Minor debridements and antifungal treatment was applied, and in the sixth month of the treatment, softening of the right maxillary bone was detected in the same area. From the biopsy sample, Candida tropicalis grew in the culture, and was treated with combined antifungal medicines. This case is presented to emphasize the feasibility of mucor infection treatment via minor debridements and antifungal medicines without any need for major surgery, and also to emphasize that breaktrough fungal infections should not be ignored, in spite of the antifungal medicines that are highly effective and have broad-spectrum. [ABSTRACT FROM AUTHOR]

Biphenotypic acute leukemia (BAL) is defined as the existence of multiple antigen coexpression in leukemic blasts or two different types of blast population. In this study, a patient who was first diagnosed with BAL and later with acute myeloid leukemia M1 (AML-M1) is presented. The patient was four-year-old male and had complaints about high fever, fatigue, lack of appetite, and weight loss for two months. % 96 L2 type blasts were identified in bone marrow aspiration, and positive values for CD79a, CD56, CD5, CD13, CD33, and MPO were observed in flow-cytometry. These findings, evaluated on the basis of "European Group for the Immunological Characterization of Leukemias (EGIL)" criteria, suggested BAL. As the steroid treatment returned no response, the flow-cytometry findings were reevaluated based on "World Health Organization (WHO)" criteria. BAL was excluded and AML M1 was considered as a diagnosis. The positive values for CD79a, CD56 , and CD5 were evaluated as coexpression. Chemotherapy was given as AML treatment, and the dramatic response was reported. This case is presented to show that, using EGIL criteria to evaluate BAL may be misleading , and thus using WHO criteria to evaluate BAL may be more appropriate. [ABSTRACT FROM AUTHOR]

The article present case studies of patients including 15-year-old male patient, diagnosed with anemia and thrombocytopenia in a state hospital, was referred to our clinic, and he was 2 years old, a bone marrow aspiration was performed because of thrombocytopenia but the bone marrow findings were normal. It mentis that 14-year-old male patient was referred to clinic upon detection of thrombocytopenia in a state hospital.

We report two male cases (4- and 5-years-old) of intrathecal methotrexate overdose. The two boys with acute lymphoblastic leukemia were to receive intrathecal injection of methotrexate. Instead of the prescribed 12 mg, they both received a dose of 120 mg. The initial cerebrospinal fluid samples showed methotrexate concentration of 2.24x10-2M in case 1 and 1.32x10-2M in case 2. The cases were successfully treated with cerebrospinal fluid (CSF) exchange and intravenous folinic acid rescue. The favorable outcome in our cases suggests that CSF exchange is safe and that folinic acid rescue may be adequate to prevent sequelae in patients subjected to intrathecal MTX overdoses up to 120 mg. We propose CSF exchange and intravenous folinic acid as the mainstay of treatment. In addition to the staff 's failure to check the drug label carefully, the marked resemblance of the two dose preparations of MTX may have been contributory. [ABSTRACT FROM AUTHOR]

Copyright of Pediatrics International is the property of Wiley-Blackwell and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Visseral leishmaniasis is a protozoan infection that is characterized by a prolonged fever, splenomegaly, hepatomegaly, hypergammaglobulinemia, progressive anemia, and pancytopenia. Splenic infarct is a rare problem, which is seen over the course of this disease. In this study, a four-year-old female patient diagnosed with visceral leishmaniasis who developed resistance to sodium stibogluconate as well as a splenic infarct is presented. Abdominal ultrasonography and computerized tomography, which were used because of the development of left upper abdominal pain on the third day of the treatment, revealed a splenic infarct. Despite the clinical improvement at the end of the first week, enlargement in the liver and the spleen along with high fever were reported on the twentieth day of the treatment. Because of the resistance to pentavalent antimonial drug, amphotericin B liposomal treatment was administered and a positive clinical response was observed. Following the treatment of only the primary disease, the splenic infarct resolved at the end of the first month without any complications. This case is presented as both drug resistance and splenic infarct are rarely seen during the course of visceral leishmaniasis. [ABSTRACT FROM AUTHOR]

Iron-deficiency anemia due to iron malabsorption and duodenal nodular lymphoid hyperplasia (NLH) has been described in children with Giardia intestinalis infection. Also, symptomatic iron-deficiency anemia is rarely encountered in male adolescents. A 14-year-old boy underwent esophagogastroduodenoscopy for investigation of symptomatic iron-deficiency anemia (hemoglobin 5.8 g/dL, mean corpuscular volume 65.3 fL, serum ferritin < 1.5 ng/mL). He had a sufficient diet for iron and recurrent bouts of diarrhea without melena. At upper endoscopy, duodenal mucosa was diffusely nodular. Histopathologic evaluation of biopsy samples from the duodenum revealed infection with Giardia intestinalis. His anemia improved with metronidazole and iron treatment. [ABSTRACT FROM AUTHOR]

Safety of blood and blood products is a major problem all over the world. Screening for the markers of infectious diseases is an incomplete solution. One of the most important steps in improving the safety of blood and blood products is donor selection. In this study, causes of donor deferral were evaluated retrospectively in the blood center of a children's hospital. Analysis of the deferrals showed that the most commonly defined causes were recent sexual exposure in high-risk activity, recent ingestion of medication, low hemoglobin level, abnormal blood pressure, being underweight, tattoos, piercing or acupuncture in the preceding 6 months, recent history of infection and presenting for a subsequent donation too soon, elevation of transaminases, presence of the markers of the infectious diseases. [ABSTRACT FROM AUTHOR]