Asian Journal of Pediatric Research

Multiple Presumed Pyogenic Liver Abscesses Following Apparently Uncomplicated Acute Appendicitis in a Child: A Case Report

A. Lotfi — 2026-09-03

Aims: To describe multiple presumed pyogenic liver abscesses developing shortly after appendectomy for acute appendicitis reported as uncomplicated in a child, and to highlight diagnostic uncertainty, portal venous findings, and management when drainage is considered unsafe.

Presentation of Case: A 7-year-old boy was admitted five days after appendectomy with fever, abdominal pain, and deterioration of his general condition. Haemoglobin was 3.5 g/dL, requiring red blood cell transfusion; white blood cell count was 24,800/mm³ and C-reactive protein was 261 mg/L. Ultrasonography and computed tomography showed multiple hepatic and pericholecystic collections, peritoneal effusion, hepatosplenomegaly, and portal cavernoma. Blood and ascitic fluid cultures were negative, and no abscess material was obtained for culture. After one week of a third-generation cephalosporin, an aminoglycoside, and metronidazole, fever and inflammation persisted; repeat computed tomography showed enlargement of the collections with capsular disruption. Treatment was escalated to intravenous imipenem, vancomycin, and metronidazole; heparin and enteral nutritional support were also initiated. Drainage was considered unsafe by the treating team because of concern for hepatic rupture. Intravenous antimicrobial therapy was continued for four weeks, with clinical and radiological improvement and a decrease in C-reactive protein to 60 mg/L. Portal cavernoma was already present on the initial imaging, and thrombophilia screening later showed reduced protein C activity.

Discussion: Appendicitis-associated liver abscesses are rare in children and are usually reported with perforated appendicitis or pylephlebitis. In this child, the appendicitis had been reported as uncomplicated, making the temporal association unusual. Because no abscess material was obtained, the pyogenic nature of the lesions remained presumptive. The chronology and significance of the portal cavernoma could not be established in the absence of previous imaging.

Conclusion: Persistent postoperative fever and abdominal symptoms should prompt abdominal imaging even after apparently uncomplicated appendicitis. When drainage is considered unsafe, prolonged antimicrobial therapy with close clinical and radiological monitoring may be effective in selected patients. A temporal association in a single case does not establish causality.

Labial Actinomycosis in a Child in University of Uyo Teaching Hospital, Uyo Akwa Ibom State South-South Nigeria: A Case Report

Ikechukwu Agwu Francis — 2026-09-04

Background: Actinomycosis is a chronic suppurative infection caused by anaerobic Gram-positive Actinomyces species that normally colonise the oral cavity and digestive and urogenital tracts. Although cervicofacial disease is recognised, isolated labial involvement is uncommon, particularly in children, and may resemble other superficial or neoplastic lesions.

Case Report: An 11-year-old male was referred from a private paediatric clinic with a two-year history of recurrent mouth blisters and ulcers, associated skin lesions, low-grade fever, throat pain, and difficulty swallowing. Examination showed swollen lips and gums, multiple well-circumscribed ulcerative lesions with white-yellow pseudomembranous exudate, areas of necrosis, friable granulation tissue, and black eschar. No sinus tract was observed.

Diagnostic Assessment: Full blood count showed anaemia, neutrophilia, and thrombocytosis; HIV serology was non-reactive, and kidney function test results were normal. Direct Gram staining of lip aspirate demonstrated filamentous branching Gram-positive rods with sulphur granules. Actinomyces israelii could not be isolated because anaerobic diagnostic tools were unavailable. The patient received penicillin therapy and showed complete clinical resolution after eight weeks of treatment.

Conclusion: The case demonstrates the diagnostic value of direct microscopy in labial actinomycosis, particularly where anaerobic culture facilities are limited, and highlights the contribution of clinical microbiology to timely recognition and management of atypical lip lesions.

Cerebellar Ataxia as a Rare Presenting Manifestation of Juvenile Systemic Lupus Erythematosus: A Case Report

A. Lotfi — 2026-09-05

Aims: To describe cerebellar ataxia as a rare presenting manifestation of juvenile systemic lupus erythematosus (jSLE) and to emphasise the diagnostic value of associated systemic findings.

Presentation of Case: An 11-year-old previously healthy girl presented with a facial eruption and gait disturbance. Examination revealed a malar rash, frontal cicatricial alopecia, chilblain-like finger lesions, hypomimia, a predominantly left-sided resting tremor, broad-based gait ataxia, motor incoordination, and involuntary blinking. Laboratory investigations demonstrated normocytic normochromic anaemia, severe thrombocytopenia, marked inflammatory activity, hypocomplementaemia, a positive direct Coombs test, and positive ANA, anti-dsDNA, anti-Sm, anti-SSA, anti-ribosomal P, and anti-RNP antibodies. The infectious work-up was negative. Brain computed tomography was normal, while magnetic resonance imaging showed widening of the cerebral cortical and cerebellar sulci, suggestive of cerebral and cerebellar volume loss. The patient received intravenous methylprednisolone pulses followed by oral corticosteroids and antimalarial therapy, with subsequent improvement in cutaneous lesions, resting tremor, gait ataxia, motor coordination, and laboratory abnormalities.

Discussion: Cerebellar ataxia is an exceptionally uncommon manifestation of SLE, particularly as an initial presentation in childhood. Attribution to lupus requires exclusion of alternative causes and integration of neurological, systemic, immunological, and neuroimaging findings.

Conclusion: jSLE should be considered in children with otherwise unexplained cerebellar ataxia or movement abnormalities when accompanying mucocutaneous, haematological, or immunological features are present.

Shapiro's Syndrome (Spontaneous Periodic Hypothermia) in a Child: A Case Report

Hajar Belmkadem — 2026-09-11

Aims: To describe a paediatric case of spontaneous periodic hypothermia (Shapiro's syndrome) occurring in the absence of agenesis of the corpus callosum, and to review the relevant literature and diagnostic approach.

Presentation of Case: A 2-year-and-9-month-old boy, previously managed twice for intestinal intussusception, was referred after a one-month history of recurrent hypothermic episodes associated with transient alterations of consciousness. Seven episodes were documented by the medical and nursing staff, with axillary temperatures between 33 °C and 35 °C lasting two to seven hours. The episodes were frequently accompanied by profuse sweating, generalised pallor, and occasional shivering, and were sometimes preceded by a febrile peak of 39 °C. Throughout the hypothermic phases, the child remained haemodynamically stable, with preserved oxygen saturation and blood glucose. Biological work-up showed no evidence of infection or inflammation (C-reactive protein, procalcitonin, and cultures were negative), viral serologies were negative, and thyroid function, cortisol, electrolytes, renal and hepatic function were normal. Both brain magnetic resonance imaging (MRI) and electroencephalography (EEG) were unremarkable, with a structurally normal corpus callosum.

Discussion: After exclusion of metabolic, infectious, endocrine, and structural neurological causes, a diagnosis of a variant of Shapiro's syndrome without agenesis of the corpus callosum was retained. The clinical sequence observed in our patient is consistent with the prevailing hypothesis of a transient downward shift of the hypothalamic thermoregulatory set-point. Management was conservative, with no pharmacological treatment initiated; at the last available follow-up, three months after discharge, the frequency of episodes had markedly decreased, with three episodes over that interval.

Conclusion: Spontaneous periodic hypothermia, although rare, should be considered in children presenting with recurrent unexplained hypothermia once more common causes have been ruled out.