Acute cardiogenic liver injury caused by heart failure in an adolescent

To the Editor:Heart failure is a systemic clinical syndrome characterized by multiple organ systems involvements[1].With the progression of heart failure,patients may present with liver-related symptoms.However,these symptoms may be misdiagnosed as primary gastrointestinal diseases which lead to treatment delay and aggravation of conditions.We retrospectively reviewed the liver function changes in an adolescent with heart failure,which will help clinicians better understand acute cardiogenic liver injury.

Biomarkers of intravenous immunoglobulin resistance and coronary artery lesions in Kawasaki disease

Background Currently,there are no reliable indicators for predicting intravenous immunoglobulin resistance and coronary artery lesions in the early stage of Kawasaki disease.Methods A total of 300 patients with Kawasaki disease were studied retrospectively.Laboratory data were compared between the intravenous immunoglobulin resistant (29 patients) and responsive groups,and between the groups with coronary artery lesions (48 patients) and without coronary artery lesions.Results The intravenous immunoglobulin resistant group had significantly higher D-dimer,globulin,interleukin-6 and serum ferritin levels in comparison to the intravenous immunoglobulin responder group.D-dimer level had a sensitivity of 87.0% and a specificity of 56.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 1.09 mg/L.Globulin had a sensitivity of 62.1% and a specificity of 82.3% for predicting intravenous immunoglobulin resistance at a cutoff point of 34.7 g/L.Serum ferritin level had a sensitivity of 42.9% and a specificity of 88.8% for predicting intravenous immunoglobulin resistance at a cutoff point of 269.7 ng/mL.The patients with coronary artery lesions had higher D-dimer and tumor necrosis factor-α level.D-dimer level had a sensitivity of 50% and a specificity of 78.6% for predicting coronary artery lesions at a cutoff point of 1.84 mg/L.Based on analysis by multivariate logistic regression,serum ferritin and globulin were independent risks for intravenous immunoglobulin resistance,D-dimer was independent risk for coronary artery lesions.Conclusions Elevated serum ferritin,globulin and D-dimer levels are significantly associated with intravenous immunoglobulin resistance in Kawasaki disease.Moreover,serum D-dimer is significantly increased in Kawasaki disease with coronary artery lesions.

Moyamoya disease associated with aortic coarctation

A12-year-old girl was referred to our hospital due to fever,numbness on the left limb and movement disorder for three days.On admission,she had a body temperature of 37.5℃,occasional cough,numbness on the left limb(severe in the left upper limb),motion limitation,difficulty to hold things with hands,drooping of the angle of the mouth,trembling of the mouth at times(persisting for seconds)and vomiting.