An 8-week-old infant girl with pertussis-induced respiratory distress, complicated by severe leucocytosis, pulmonary hypertension and respiratory failure is reported. She was treated with mechanical ventilation, exchange transfusion and other supportive measures. A single-volume exchange transfusion significantly reduced the elevated white blood cell count and stabilised her condition. This case underscores the potential role of exchange transfusion as a life-saving intervention in critical pertussis cases with severe leucocytosis.

Thalassaemia is the most common inherited haemoglobin disorder worldwide and a major health problem. Beta-thalassaemia major generally presents with a normal serum lipid profile, but there have been a few reports of its association with hypertriglyceridaemia, the exact pathogenesis of which remains unknown, and where early and regular blood transfusions ameliorate hypertriglyceridemia, thereby preventing its complications and the need for medical treatment of hypertriglyceridemia. This entity was seen in a 6-month-old infant girl who presented with severe anaemia, failure to thrive and organomegaly, and was incidentally found to have hypertriglyceridaemia. Hypertriglyceridaemia thalassaemia syndrome has rarely been described.

is a common cause of community-acquired pneumonia (CAP) in children. While infection is typically mild and self-limiting, individuals of all ages may develop severe CAP or extrapulmonary manifestations such as -induced rash and mucositis (MIRM). Severe pneumonia with concurrent MIRM in an 8-year-old boy is reported. The clinical course was complicated by persistent fever, severe mucositis and bilateral multi-lobar pneumonia requiring advanced respiratory support. Initial antibiotic and supportive therapy yielded little improvement, but the introduction of corticosteroids resulted in marked clinical improvement of both the pneumonia and mucositis. This case emphasises that MIRM may indicate a more severe course of infection, and that early corticosteroid therapy could be beneficial in such cases.: CAP: community-acquired pneumonia; CRP: C-reactive protein; EM: erythema multiforme; HFNC: high-flow nasal cannula; MIRM: Mycoplasma pneumoniae-induced rash and mucositis; PCR: polymerase chain reaction; RIME: reactive infectious mucocutaneous eruption; SJS: Stevens-Johnson syndrome; TEN: toxic epidermal necrolysis; MIRM: .

Acute acalculous cholecystitis (AAC) is a rare but potentially serious disorder associated with Kawasaki disease (KD). Studies have demonstrated that patients presenting with severe abdominal symptoms owing to KD have increased resistance to intravenous immunoglobulin (IVIG) and a higher rate of coronary artery aneurysms. A 5-year-old boy was brought to the emergency department with fever, abdominal pain, vomiting and jaundice. He presented as ACC and was subsequently diagnosed with KD because the symptoms and signs he developed during admission were consistent with that. He was treated with IVIG and high-dose aspirin, and was discharged 7 days later with complete resolution of the symptoms. AAC acute acalculous cholecystitis; ALT alanine transaminase; AST aspartate aminotransferase; CMV cytomegalovirus; CRP C-reactive protein; EBV Epstein-Barr virus; GGT gamma-glutamyl transferase; IVIG intravenous immunoglobulin; KD Kawasaki disease.

A 3-year-old boy with atypical skin lesions was diagnosed with syphilis, probably acquired through close daily contact with his grandparents. The case highlights the critical need for syphilis testing in children with non-specific skin findings, particularly when familial exposure is suspected. Physicians should prioritise thorough assessment, including detailed enquiry into the child's medical history, feeding practices, lifestyle and potential exposure to infection. Prompt screening of close contacts including family members and carers is essential in order to identify infection sources and prevent further transmission.: ANA: Antinuclear antibody; ESR: Erythrocyte sedimentation rate; RPR: Rapid plasma reagin; TPPA: particle agglutination.

Kawasaki disease is a common childhood vasculitis of unknown aetiology, with infectious triggers often proposed. The association of Kawasaki disease with Dengue is rare. It often poses a diagnostic challenge owing to the close overlap of clinical features and a lack of diagnostic tests for Kawasaki disease. Concominant Dengue fever and Kawasaki disease in a 7-month-old boy is reported, and the possible association between the two conditions is considered. He presented with an acute febrile illness and was diagnosed with Dengue fever based on positive serology. Despite standard management for Dengue, he remained febrile and developed features suggestive of incomplete Kawasaki disease. Echocardiogram demonstrated a small coronary artery aneurysm. There was a dramatic response to intravenous immunoglobulin and aspirin. Follow-up at 6 weeks showed complete resolution of the aneurysm without residual cardiac sequelae. Kawasaki disease should be considered in children with Dengue who have persistent fever or evolving clinical features. Prompt recognition and treatment are essential to prevent coronary artery complications. The rare co-existence of Dengue and Kawasaki disease raises the question of whether this is a mere association or a potential trigger, highlighting an area for future research.

To describe the socio-demographic and clinical characteristics, treatment outcome and predictors of mortality in patients under 18 years of age with post-neonatal tetanus (PNT) in Abeokuta.

Henoch-Schoenlein purpura (HSP) in children is the most prevalent form of vasculitis. While the lungs are recognised as potential target organs in several vasculitides during childhood, pulmonary involvement in HSP is exceptionally rare. A 5-year-old girl presented with haemoptysis during week 3 of HSP vasculitis. Radiological findings from a pulmonary computed tomography scan confirmed alveolar haemorrhage. The patient was administered pulse corticosteroid therapy at a dose of 30 mg/kg/day for 3 days, followed by a regimen of 2 mg/kg/day and azathioprine. During follow-up, the corticosteroid treatment was gradually tapered, and the patient remains under azathioprine monotherapy without any complications. Pulmonary involvement in HSP can be life-threatening; thorough systemic examination is therefore imperative. Further evaluation should be considered necessary when assessing patients with HSP. Close monitoring for respiratory symptoms is essential in the later stages of the disease.

Pre-school children are at highest risk for dog bites. A 2-year-old boy was bitten by a little Pinscher nano dog causing deep injuries which were not apparent on first evaluation. A few hours later he had severe respiratory failure, consistent with subglottic injury. Marked neck enlargement was caused by widespread subcutaneous emphysema. The airway oedema and superimposed systemic infection required a week of intensive care to improve and restore spontaneous breathing. Even an apparently benign bite lesion can evolve into a life-threatening respiratory condition, and there should be a high index of suspicion for every neck lesion in a child.

In children, anaemia is an uncommon presentation of hypothyroidism. The diagnosis was delayed in two girls with auto-immune atrophic thyroiditis owing to an absence of goitre and the unusual presentation of fatigue and anaemia. The first patient was a 15-year-old girl who presented with fatigue and pallor. Results of the initial investigation were compatible with iron deficiency anaemia. However, after 2 years of iron supplementation, the anaemia had not been resolved. Owing to refractory anaemia and recent mild neutropenia, a bone marrow (BM) study was performed. The BM histopathology demonstrated hypocellular marrow, compatible with BM suppression. Tests for low thyroid hormone levels (one of the causes of BM suppression) revealed overt hypothyroidism. She also had a mildly decreased estimated glomerular filtration rate (eGFR). The second patient was a 9-year-old girl who presented with a 5-month history of fatigue and a weight gain of 4 kg in a month. Initial laboratory tests showed macrocytic anaemia, decreased eGFR and normal urinalysis. Further investigation confirmed overt hypothyroidism. After levothyroxine treatment, the anaemia was resolved in both patients and the eGFR normalised. This report demonstrates that anaemia in children can be the initial presentation of hypothyroidism. Hypothyroidism should be considered as a possible cause of anaemia, especially anaemia refractory to conventional treatment. Additionally, goitre as a clue to diagnosing acquired hypothyroidism owing to auto-immune thyroiditis might not be apparent in atrophic thyroiditis. Unrecognised hypothyroidism might lead to unnecessary investigations and delay appropriate treatment. Normalisation of thyroid function in patients with hypothyroidism results in the resolution of anaemia and the normalisation of eGFR.

Lactate is a by-product of thiamine-deficient cellular metabolism, and hyperlactataemia can indicate severe illness. However, little is known about the clinical significance of hyperlactataemia in thiamine deficiency disorders.

Whilst vertical transmission of Zika virus (ZIKV) is established as the cause of congenital Zika syndrome (CZS), knowledge of this emerging disease remains incomplete.

The prevalence of post-tuberculous endobronchial stenosis in children is unknown and it is rarely reported. In adults, it varies from 10% to 40%. It has a variable spectrum of presentation; cough is the most common, but there can also be haemoptysis, dyspnoea, chest pain and wheezing. The non-specific symptoms and co-occurrence with parenchymal disease can delay the diagnosis. Bronchoscopy and computed tomography (CT) are the investigations of choice. Depending on the symptoms, chest imaging and bronchoscopic findings, the treatment can be conservative, medical or interventional. A 15-year-old male is presented; he was a known case of clinically and radiologically diagnosed pulmonary tuberculosis and was treated for 6 months with anti-tuberculous drugs. On presentation, there was a progressive cough, exertional dyspnoea, collapse consolidation of the left lung, ipsilateral mediastinal shift and partial stenosis of the left distal main bronchus on contrast-enhanced CT. Flexible fibre-optic bronchoscopy demonstrated atresia of the anterior segment and stenosis of the inferior lingular segment of the left bronchus with a normal right bronchus. Post-tuberculous bronchial stenosis should be focused on and managed early to prevent fibro-stenosis. Early treatment in a symptomatic patient is linked to a successful outcome. The boy showed significant clinical improvement with spirometry, chest physiotherapy and supportive measures, although the radiological features persisted.: ATT: anti-tuberculous therapy; CT: computed tomography; EBTB: endobronchial tuberculosis; ESR: erythrocyte sedimentation rate; HRCT: high-resolution computed tomography; LUL: left upper lobe; TB: tuberculosis.

Congenital malaria, characterised by low parasitaemia in newborns' peripheral blood, is difficult to diagnose by conventional techniques. Owing to its high sensitivity, polymerase chain reaction (PCR) allows for effective detection of low-density plasmodium infections. This study determined the prevalence of congenital malaria by PCR in newborns of mothers living in a malaria-endemic area of Kinshasa, Democratic Republic of Congo (DRC).

Impaction of button batteries (BB) in children is not rare.

This study focuses on emerging conflicts between modern medical practice and fundamentalist religious views in Pakistan. It addresses the issue of the Mothers' Milk Bank at the Sindh Institute of Child Health and Neonatology in Karachi which was recently shut down following an Islamic , demonstrating their considerable effect on public health policies. It also addresses milk banks globally and how these have been accommodated in the context of Islamic laws on breastfeeding and the concept of milk kinship []. It advocates the need for milk banks in Pakistan for ethical reasons to lower infant mortality and for better infant nutrition. A framework for policies compliant with Islamic law is suggested, working with religious leaders, and raising awareness to ensure that healthcare systems accord with cultural and religious practices.: CII: Council of Islamic Ideology; Fiocruz: Oswaldo Cruz Foundation; MMBs: mothers' milk banks; NICU: neonatal intensive care unit; SABR: South African Breastmilk Reserve; SICHN: Sindh Institute of Child Health and Neonatology; V-MAK: Vatsalya-Maatri Amrit Kosh.

Individuals with autism spectrum disorder (ASD) often exhibit limited food preferences and sensory sensitivity. Co-existing food allergies in this population can further limit their already restricted diets, increasing the risk of nutritional deficiencies. Two children with ASD and food allergies presented with non-specific symptoms and were found to have hypocalcaemia secondary to severe vitamin D deficiency. The report highlights the importance of a greater degree of suspicion of vitamin D deficiency in children with co-existing ASD and food allergies. Non-specific symptoms related to hypocalcaemia can be difficult to evaluate in non-verbal patients. A thorough dietary history is an essential part of the care of children with ASD. It is proposed that limited diets should be screened for common nutritional deficiencies.

Pulmonary arteriovenous malformation (PAVM) is a rare, pathological, intrapulmonary, right-to-left shunt resulting from abnormal communication between the pulmonary artery and pulmonary vein. It can remain asymptomatic and/or suddenly manifest with life-threatening complications. A 13-year-old girl presented with giddiness, falling over and loss of consciousness. She was the fourth child of non-consanguineous parents, and two of her older siblings had died: a girl at 2 years of age owing to suspected pneumonia, and a boy at 8 years of age owing to falling over and convulsions. She had dyspnoea, central cyanosis, clubbing, severe hypoxaemia, polycythaemia and iron deficiency. Chest radiograph demonstrated well defined homogeneous opacity in the right hilar region. The thoracic CT angiogram revealed a large PAVM in the superior segment of the right lower lung fields. Percutaneous cardiac catheterisation and coil embolisation of the PAVM were successfully undertaken. Her oxygen saturation improved to 95-97% in room air. She remained asymptomatic during 2 months of follow-up and then by telephone for 1 year post-procedure. However, her parents have not since attended the hospital for repeat examination and scans. This case highlights the timely, successful treatment of a large PAVM in an adolescent girl and emphasises the need for awareness in paediatricians and other healthcare workers about PAVMs, which, although rare, are potentially life-threatening, especially in adolescents in whom a comorbidity such as iron deficiency could increase the risk of PAVM complications.