Transient Macroamylasemia in a Severely Multiple-Handicapped Child Following the Development of Acute Bronchitis

Macroamylasemia is a condition of elevated serum amylase levels in which normal serum amylase form a complex with high molecular weight proteins such as immunoglobulins. This is a case report on a patient with macroamylasemia following acute asthmatic bronchitis. A 5-year-old male with cerebral palsy and developmental retardation was admitted to our hospital because of high fever and severe cough. Treatment of the respiratory symptoms provided symptomatic improvement, but the serum amylase levels became suddenly elevated. Although acute pancreatitis associated with respiratory infection was initially suspected, a predominant salivary isoamylase, normal serum lipase level, low urine amylase level, and low amylase-creatinine clearance ratio (ACCR) (0.58%) indicated macroamylasemia. The serum amylase level decreased, and the ACCR increased within normal range 2 weeks after discharge. Both of these indicators have been within normal range over the past year. Transient macroamylasemia can be misdiagnosed as acute pancreatitis, especially in a severely multiple-handicapped child who is unable to complain. The ACCR is useful in the diagnosis of macroamylasemia.

Early-Stage Juvenile Fibromyalgia in a 12-Year-Old Girl

Juvenile fibromyalgia (JFM) is often diagnosed at a later stage. Therefore, little is known about its early phase. A 12-year-old girl with persistent lumbago without fever consulted an orthopedist, but imaging studies showed no abnormalities and analgesics were ineffective. She therefore visited our pediatric clinic. On digital palpation, she had pain in 13 of the 18 tender point sites of fibromyalgia. The blood test results were unremarkable. A medical interview revealed character tendencies often seen in patients with JFM;she was serious-minded, uncompromising, and showed excessive concern for others. Furthermore, psychological stress for the approaching annual sports day might have built up. All factors considered, early-stage JFM was the probable diagnosis. The patient accepted the diagnosis and understood that the disease may be psychogenic. Getting through the sports day cured her symptoms. This case highlights the importance of initial care, including a detailed explanation, in those with JFM.

Efficacy of the H2-receptor antagonist famotidine on chronic spontaneous urticaria in children

Urticaria is a common pediatric skin disorder. Histamine H1-receptor antagonists are effective in chronic as well as acute urticaria. When H1-anti-histamines are ineffective, add-on use of H2-receptor antagonists is thought to give better symptom relief. However, there are few reports on the therapeutic efficacy in pediatric patients. We retrospectively reviewed the medical records of pediatric patients with chronic spontaneous urticaria (csU) who met the following criteria. They were consulted our outpatient clinic between April 2010 and March 2012;were unsuccessfully treated with H1 antihistamines;and were treated with add-on H2-receptor antagonist (famotidine). In six patients who met the inclusion criteria (mean age 6.1 ± 5.1 years), urticaria activity score was significantly decreased from 4.3 ± 0.8 just before administration of famotidine to 1.3 ± 1.0 on the first outpatient visit within 4 weeks after the first administration of famotidine

Transient hyperphosphatasemia:Possible association with pediatric acute respiratory infection

Importance Acute respiratory infections are quite prevalent in children.Transient hyperphosphatasemia(TH)is defined as the transient elevation of serum alkaline phosphatase(ALP)level,which occurs mainly in infants and children without liver or bone disorders.Although no apparent cause has been identified,a possible association of respiratory infections with TH has been reported in the literature.Objective In this study,we aimed to investigate the association between TH and respiratory infectious diseases.Methods We collected the results of biochemical investigations,including ALP level,for a period of 5 years in our hospital.We then examined the patients with transiently elevated ALP levels of>2000 U/L.Results During the observation period,1501 blood samples were collected from 1097 patients.Marked elevation of serum ALP level was observed in 12 patients.All patients with hyperphosphatasemia,except for one with Fanconi syndrome attributable to the underlying Wilson’s disease,were aged<5 years and were diagnosed with TH.Ten of these 11 patients with TH had acute respiratory infections.Marked ALP elevation was not found in any patients with non-inflammatory diseases.ALP isoenzyme profiles showed a characteristic pattern in all six patients in whom the ALP isoenzyme test was conducted.Interpretation Our results suggest an association between respiratory infections and TH.The consideration of TH in patients with acute respiratory infections may lead to earlier and accurate diagnosis of this condition,thereby avoiding unnecessary medical interventions.