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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.128, No.7, July 2024
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Review
Title
A Case Report and Review of Literature about Multisystem Inflammatory Syndrome after COVID-19 Vaccination
Author
Koji Fujimoto Seigo Korematsu Yasuko Urushihara Youichi Iwamoto Keiko Mizuta Satoshi Masutani and Koichi Moriwaki
Department of Pediatrics, Saitama Medical Center, Saitama Medical University
Abstract
Reports of MIS-C after infection with COVID-19 are increasing. However, there are few reports of MIS-C after COVID-19 vaccination.
The patient was a 14-year-old boy without recurrence of COVID-19 or contact with COVID-19. He received the third dose of the COVID-19 vaccine 4 weeks before the onset of illness. He developed right cervical discomfort, fever, cough, and enlarged right cervical lymph nodes on the third day of illness; however, PCR for SARS-CoV-2 was negative. On the 4th and 5th days, he developed diarrhea and a rash on the body. He was admitted to the hospital on the 8th day of illness. His CK level was 225 U/L, his left ventricular ejection fraction was mildly decreased at 55%, his troponin I level was 174.7 pg/mL, and ST changes were observed on electrocardiography. These findings suggested the development of myocarditis. Accordingly, the patient was diagnosed with MIS-C. High-dose immunoglobulin therapy was started on the 11th day of illness. After the initiation of treatment, all symptoms, the left ventricular ejection fraction, the patient's laboratory data improved, and the patient was discharged from the hospital.
The measurement of SARS-CoV-2 antibody titers revealed that his anti-S antibody titer was 592 AU/mL and his anti-N antibody titer was <1.0 AU/mL. These results indicated that the COVID-19 vaccine might have caused MIS-C. The current study shows that the cause and pathogenesis of the syndrome remain to be fully analyzed. Further cases should be accumulated to investigate the clinical features of MIS-C after COVID-19 vaccination and after COVID-19 infection.
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Original Article
Title
Effects of Parent Training for Parents of Children with Neurodevelopmental Disorders
Author
Shigeichi Kobayashi
Department of Developmental Behavioral Pediatrics, Shizuoka Children's Hospital
Abstract
A group-based parent training (PT) program was conducted for parents of children with neurodevelopmental disorders, and the effects of PT and the participants' perceptions about the usefulness of PT were investigated. The subjects were 52 children and their mothers, with various combinations of diagnoses of neurodevelopmental disorders in children. Mothers who participated in PT were asked to fill out questionnaires about their child's Attention-Deficit/Hyperactivity Disorder (ADHD) symptoms, child's behavioral problems, parent's mental health, and parent's child-rearing confidence at pre-participation, post-participation and 2 months, 6 months, and 1 year after the end of PT. The main effects were found to show significant improvement in all questionnaires at post-participation compared to pre-participation, and this continued until one year later. The usefulness of PT as a whole was highly rated both at the end of PT and one year later, but varied among individual PT items, which we considered to be an issue for further investigation.
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Original Article
Title
Aseptic Meningitis Caused by Mumps Virus Vaccine Strains in Children Hospitalized at a Regional Center in Aichi, Japan 2008―2022
Author
Kensei Gotoh Naoko Nishimura Yotaro Kondo Masanori Sugiura Mai Umehara Naoto Nishimura Takuya Akano Takuma Ando Kanayo Ochiai Haruka Mimatsu Koji Takemoto and Takao Ozaki
Department of Pediatrics, Konan Kosei Hospital
Abstract
The implementation of routine mumps immunization requires exact data about meningitis caused by mumps virus vaccine strains. This retrospective study enrolled 246 children hospitalized for aseptic meningitis between April 2008 and March 2022. To assay mumps IgG and IgM enzyme immunoassay antibodies, paired serum samples were obtained. For patients immunized with the mumps vaccine within 5 weeks (postvaccinal meningitis), detection tests of mumps virus RNA were conducted on spinal fluid samples. Vaccine and wild strains were differentiated via restriction fragment length polymorphism assay. Of the 246 patients, 24 were diagnosed with postvaccinal meningitis, 138 with mumps meningitis, and 84 with other meningitis. In 24 patients with postvaccinal meningitis, mumps virus RNA was detected in 14, who had vaccine-strain meningitis (vaccine strains Torii 5 and Hoshino 9). The clinical picture of patients with vaccine-strain meningitis were as follows: the median number of days from vaccination to symptom onset, 22.5 days; median age, 1.4 years; no sex predilection; rate of parotid swelling, 0%; rate of fever, 100%; median maximal temperature, 40.0°C; median duration of fever, 6.5 days; rate of headache, 29%; rate of nausea or vomiting, 71%; rate of neck rigidity, 29%; and median cerebrospinal fluid cell count, 337/μL. The median age and rate of headache were significantly lower in patients with vaccine-strain meningitis than in 138 patients with mumps meningitis. The annual number of patients with vaccine-strain meningitis was seven within the last 3 years. To prevent the omission of vaccine-strain meningitis, a detailed history of vaccination is necessary.
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Case Report
Title
Ivabradine for Pediatric Supraventricular Tachycardia
Author
Toshiaki Kan Yotaro Misaki Takuya Matsuda Takao Kazuta Hikoaki Oba Taiki Haga Yoko Akamine and Yasunori Otsuka
Department of Pediatric Intensive Care Medicine, Osaka City General Hospital
Abstract
Ivabradine is a drug used for treating chronic heart failure that improves prognosis by decreasing the heart rate without suppressing cardiac function. Studies have reported its efficacy in treating tachyarrhythmia by increasing automaticity. In this study, ivabradine was used in four patients refractory to existing antiarrhythmic agents (postoperative junctional ectopic tachycardia in three patients and pheochromocytoma-induced sinus tachycardia in one patient). Heart rate reduction to the target level was achieved in all patients, and other antiarrhythmic agents could be reduced or discontinued. One patient experienced bradycardia. However, the blood pressure did not decrease, and the patient improved with dose reduction. Ivabradine is a potential treatment option for refractory pediatric supraventricular tachycardia but necessitates close monitoring for adverse effects.
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Case Report
Title
A 5-year-old Boy Diagnosed with Klinefelter Syndrome Variant Following Dental Evaluation
Author
Mami Uegami1) Gaku Murakami1) Ryo Otaka2) and Tadashi Shiohama3)
1)Department of Pediatrics, Kameda Medical Center
2)Department of Clinical Genetics, Kameda Medical Center
3)Department of Pediatrics, Graduate School of Medicine, Chiba University
Abstract
Klinefelter syndrome is one of the most common Sex Chromosome Aneuploidy, occurring in 1 in every 660 male. Most cases go entirely undiagnosed or are diagnosed during adulthood after male infertility is observed. Thus, diagnosis during early childhood is rare. In the present case, a 5-year-old boy with developmental language disorder and developmental coordination disorder visited a pediatric dentist for multiple caries. The dental findings of Taurodont teeth, enamel hypoplasia, and lack of permanent teeth led to the diagnosis of a variant of Klinefelter syndrome (karyotype 48, XXYY). In addition to the dental findings, the patient had a tall stature (+3.3 Standard deviation); however, there was no gynecomastia or testicular dysplasia. An early diagnosis can help prevent complications such as learning disability, social maladaptation, etc., making it important to consider this disease in the differential diagnosis when the patient presents with tall stature along with language disorder. Pediatric dental evaluation can be useful for the early diagnosis of variants of Klinefelter syndrome.
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Case Report
Title
A 12-year-old Girl with Myasthenia Gravis Who Had Dysphagia
Author
Riu Homma1) Takuya Hayashi1) Keiichi Motoyama3) Jun Kubota2) Ryuki Matsuura2) and Ikuya Ueta1)
1)Emergency and Critical Care Center, Saitama Children's Medical Center
2)Department of Neurology, Saitama Children's Medical Center
3)Department of General Medicine, Ibaraki Children's Hospital
Abstract
Myasthenia gravis is an important disease in emergency medicine because it can lead to severe respiratory failure. However, the diagnosis of myasthenia gravis can be difficult due to the non-specificity of the symptoms and the variability of symptoms and physical findings. We report a case of a 12-year-old girl who had been healthy all her life. She visited our primary hospital due to respiratory failure caused by aspiration of food, and our transport team was dispatched. Upon arrival, the patient presented with respiratory and consciousness problems and was intubated and transported to our hospital. On day 2, her respiratory and consciousness statuses improved, and she was extubated. However, her respiratory status deteriorated due to the aspiration of saliva, and she was reintubated shortly afterward. Thereafter, we suspected myasthenia gravis based on a detailed medical history and performed various tests to establish a clinical diagnosis. The patient was diagnosed with myasthenia gravis based on a positive repetitive electromyography positive Tensilon test, and positive anti-acetylcholine receptor antibody test. Although myasthenia gravis in children is rare, respiratory failure due to aspiration or respiratory muscle weakness may be the initial manifestation of the disease. The symptoms are nonspecific and can sometimes be mistaken for a disturbance of consciousness or conversion disorder. Therefore, myasthenia gravis should be considered a possibility in the case of an episode of unnatural aspiration in a healthy child.
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