RN&C: Ano de 2024
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- Miliary tuberculosis – A challenging diagnosisSilva, Catarina Pinto; de Sousa, Beatriz; Lima, Joana; Vasconcelos, Sofia; Rebelo, Alícia; Lobo, Ana Luísa; Fernandes, AlexandreTuberculosis is a challenging diagnosis with marked clinical heterogeneity that can lead to diagnostic delay and serious and potentially life-threatening problems. The most prevalent form of the disease is pulmonary tuberculosis. The present case has unique features as in that it describes a case of miliary tuberculosis in an immunocompetent adolescent vaccinated with the Bacillus Calmette-Guerin vaccine and raises awareness of the occurrence of normal radiograph and early in the course of pulmonary tuberculosis, and normal head tomography even in the presence of tuberculous meningitis, highlighting the need for a high index of suspicion. It also shows that tuberculosis should be included in the differential diagnosis of fever of unknown origin with weight loss, even when no epidemiologic link has been established
- Snakebite poisoning: A neglected diseaseDe Matos, Bárbara Barroso; Gaspar, Nélio Santos; Ferreira, SaraSnakebite is a rare but potentially fatal cause of poisoning in children worldwide. It is a neglected public health issue in Europe, mainly affecting farmers and children, the latter suffering more severe consequences due to their small body mass. If poisoning is suspected, hospitalization of these patients is mandatory for clinical monitoring and early initiation of therapy. Snakebite can be a medical emergency. However, unlike many other serious health conditions, there is a highly effective treatment – anti-ophidian serum. It is crucial to invest in more effective and safer serums and to make them easily accessible in the event of a snakebite. The case of an adolescent affected by viper bite, its treatment and clinical course is reported.
- Pediatric hospitalizations for respiratory infections: Before and after SARS-CoV-2Monteiro, Sara; Salazar, Luís; Oliveira, João; Souto, Mariana; Morais, Lurdes; Ramos, Ana; Ferreira-Magalhães, ManuelIntroduction: With the emergence of the COVID-19 pandemic, several non-pharmacological measures were adopted to prevent and control the transmission of SARS-CoV-2. Objective: To compare pediatric hospitalizations for acute respiratory infections (ARIs) before and after the emergence of SARS-CoV-2. Materials and Methods: This was a retrospective, observational study of admissions for ARIs in the pediatric ward of a tertiary hospital between April 2018 and March 2021. Inclusion criteria comprised: hospitalization of pediatric patients ([0-17[ years); length of stay >24 hours; and a respiratory infection diagnosis code from ICD-10. Data were collected using electronic clinical records. The first two years were considered ‘non-COVID-19 years’ (year[Y]1 and Y2), while the period between April 2020 and March 2021 was considered the ‘COVID-19 year’ (Y3). Results: A total of 783 hospitalizations were included in the analysis. There was a significant decrease in ARIs admissions in Y3 compared to Y1 and 2 (-67% from Y2 to Y3; p<0.001), with a decrease in the proportion of bronchiolitis cases (-42% from Y2 to Y3; p<0.001) and an increase in pneumonia cases (+124% from Y2 to Y3; p<0.001). There was a significant decrease in the incidence of respiratory viruses from Y2 to Y3 (76.6% vs. 56.4%; p<0.001), mainly driven by a decrease in respiratory syncytial virus (RSV; 46.8% in Y2 vs. 2.0% in Y3; p<0.001). Conversely, there was a significant increase in the incidence of rhinovirus from Y2 to Y3 (15.3% vs. 22.8%; p<0.001), and SARS-CoV-2 was identified in 31.7% of cases in Y3. More chest computed tomography scans were performed (5.6% vs. 10.9%; p<0.001) and more systemic steroids were used (26.3% vs. 40.6%; p=0.023) from Y2 to Y3. Conclusions: Population-based non-pharmacological measures implemented during the COVID-19 pandemic were associated with a reduction in pediatric hospitalizations for ARIs. The decrease in ARIs due to RSV is particularly noteworthy in this pandemic context.
- Lymphadenopathy, weight loss, and anal lesion in a teenagerSousa, Jessica; Nisa, Madalena Meira; Coelho, Sónia; Antunes, JoaquinaSyphilis is a systemic disease with an increasing incidence in adolescents and young adults. Clinical manifestations can be variable and diagnosis requires a high index of suspicion, as syphilis can mimic other systemic diseases. Condylomata lata is a highly infectious manifestation of secondary syphilis, reported in 9-44% of cases. Here is reported the case of an adolescent girl who presented with inguinal lymphadenopathies, urinary and constitutional symptoms, and a history of unprotected sex with her boyfriend, who had been previously diagnosed with a genital ulcer. A complete physical examination was performed, and the detection of an anal lesion raised the hypothesis of perianal condylomata lata as a manifestation of secondary syphilis. All signs and symptoms of infection resolved with treatment. Early detection, appropriate treatment, and prevention of transmission are essential to reduce the burden of the disease.
- A case of unexpected travelersSilva, Ana Castelbranco; Lança, Ana Ferreira; Nunes, Tómas; Martins, Rita; Ferreira, Maria GomesHuman myiasis is the infestation of humans with dipterous larvae. Cutaneous myiasis is the most common form and is one of the most common travel-associated skin diseases. The condition should be suspected when furuncle or boil-like skin lesions are observed in patients travelling from endemic regions. Herein is described the case of a toddler who had travelled from Guinea-Bissau seven days earlier and presented with a six-day history of painful furuncle-like swellings on the left thigh and scrotum. Two larvae were collected from one of the lesions, and entomological analysis confirmed the diagnosis of cutaneous myiasis. Complete larvae extraction is the primary treatment goal, and adequate preservation of the maggots is essential for public health analysis.
- Pruritic rash in a child – Clinical caseAlba, Diana; Pimenta, Sofia; Machado, Ângela; Ferreira, Jorge AbreuUrticaria multiforme (UM) is an allergic hypersensitivity reaction characterized by the acute onset of polycyclic and annular wheals with ecchymotic centers. It is more common in children under 4 years of age, who typically present with a pruritic rash and nontoxic appearance. The diagnosis is clinical. The condition usually has a favorable response to antihistamines and self-limited course. UM is probably underdiagnosed as it is often confused with erythema multiforme and serum sickness-like reaction. Herein is reported a case of UM in a four-year-old boy, followed by a review of the literature on the subject.
- From behavioral inhibition in toddlers to anxiety disorder: Influencing factorsMonteiro, Maria do Rosário; Rodrigues, Márcia; Martins, VâniaBehavioral inhibition (BI), a biologically driven temperamental trait defined by fearful, avoidant, and withdrawn reactions to novelty, is known to represent an early vulnerability in the development of anxiety disorders. Herein is reported the case of two 18-month-old twins whose parents exhibited high levels of anxiety, restricting the infants’ exposure to new stimuli and experiences. One of the twins exhibited inhibited behaviors with high physiological activation and met criteria for inhibition to novelty disorder. Several factors may predict the persistence of BI across the lifespan and moderate its association with later anxiety disorders, including cognitive or attentional biases, variations in neural functioning, attachment processes, parental psychopathology, and parenting practices. The COVID-19 pandemic exacerbated parental anxiety and pre-existing risk factors in particularly vulnerable children.
- Sever’s disease: A diagnosis to rememberVieira, Daniela Costa; Pinto, Sara Martins; França, Ângela Santos; Silva, Margarida Trigo; Paniagua, ClaudiaSever’s disease, or calcaneal apophysitis, results from a local inflammatory process at the calcaneal growth plate and is one of the most common causes of disabling heel pain in physically active children.Herein is described the case of a ten-year-old child with chronic insidious pain in the left heel associated with physical activity. Physical examination led to the diagnosis of Sever’s disease. After appropriate treatment, a marked improvement in the child’s clinical status was noted.As a common cause of heel pain in children, this condition can be identified and diagnosed in primary care, with the family physician being responsible for its management and explaining its benign nature.
- Bronchial carcinoid tumor as a cause of recurrent pneumoniaGomes, Rita; Carvalho, Catarina; Silva, Gisela; Silva, Sílvia Ferreira; Paupério, Gonçalo S; Carvalho, Fátima; Barbosa, TelmaNeuroendocrine tumors (NETs) are the most common primary lung neoplasms. Clinical manifestations can be subtle, and chest radiograph usually shows non-specific findings, often leading to delayed or inaccurate diagnosis. Despite their indolent nature, NETs have metastatic potential and can cause significant morbidity. Early diagnosis is critical for optimal management, as surgical resection can be curative. The challenge is to correctly diagnose this rare entity while avoiding unnecessary testing. Patients with suspected NETs should be referred to a tertiary hospital for multidisciplinary evaluation, and bronchoscopy should not be delayed. Herein is reported the case of an adolescent with asthma who presented with nonspecific respiratory and constitutional symptoms. The persistence of symptoms and imaging alterations despite multiple treatments for recurrent pneumonia raised clinical suspicion of a more serious underlying condition, leading to the diagnosis of bronchial NET.
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