Browsing by Author "Hoole, T.J."

Filter results by typing the first few letters
Now showing 1 - 4 of 4
  • Thumbnail Image
    Item
    Acute on chronic osteomyelitis due to coliforms in a Sri Lankan child with homozygous sickle cell disease
    (Sri Lanka College of Paediatricians, 2021) Hoole, T.J.; Arunath, V.; de Silva, M.H.A.D.; Muthukumarana, O.G.W.; Kumarasiri, I.M.; Rathnasiri, G.B.A.M.R.; Mahendra, G.; Premawardhena, A.; Mettananda, S.
    No Abstract Available
  • Thumbnail Image
    Item
    Severe disfiguring scalp and facial oedema due to Henoch–Schönlein Purpura in a child
    (Hindawi, 2020) Arunath, V.; Athapathu, A.S.; Hoole, T.J.; Aruppala, H.; Rathnasri, A.; Ranawaka, R.; Mettananda, S.
    ABSTRACT: Henoch–Schönlein purpura is a small vessel vasculitis that usually presents with palpable purpura, arthritis, abdominal pain, and nephritis. Subcutaneous oedema of dependent areas is common; however, oedema in the scalp is extremely rare especially in children older than two years. Here, we report a child with massive disfiguring scalp and facial oedema due to Henoch–Schönlein purpura. An eight-year-old boy presented with characteristic palpable purpuric rash and extensive disfiguring scalp and facial swelling for five days. He complained of blurred vision, vomiting, and severe headache on the day of admission. Examination revealed an ill child with extensive oedema of the face and scalp that was tender on palpation. His blood pressure was above the 99th percentile, and he had exaggerated deep tendon reflexes and extensor plantar responses. All biochemical investigations including renal function tests were normal. Noncontrast CT head showed normal brain, with marked soft tissue swelling of the scalp. Ultrasonography showed soft tissue oedema within and surrounding facial muscles without evidence of neck vessel compression. Urine analysis revealed microscopic haematuria on day 14 of the illness, and immunohistochemical staining of renal biopsy confirmed Henoch–Schönlein purpura nephritis. In conclusion, this case report presents a child with severe, disfiguring scalp and facial oedema due to Henoch–Schönlein purpura. It highlights that severe subcutaneous oedema of Henoch–Schönlein purpura can involve any part of the body not limiting to dependent areas.
  • Thumbnail Image
    Item
    A Sri Lankan boy with Thurston syndrome (type V oro-facio-digital syndrome)
    (Sri Lanka College of Paediatricians, 2021) Athapathu, A.S.; Aruppala, A.A.H.S.; Hoole, T.J.; Arunath, V.; Rathnasiri, G.B.A.M.; Mettananda, S.
    No abstract available
  • Thumbnail Image
    Item
    A Sri Lankan infant with immunoglobulin resistant incomplete Kawasaki disease with a vesicular psoriasiform rash, hypertension and late onset small joint arthritis: a case report
    (BioMed Central, London, 2022) Hoole, T.J.; Athapathu, A.S.; Abeygunawardene, A.D.
    Background: Kawasaki disease (KD) is a medium and small vessel vasculitis which usually has a good response to immunoglobulin therapy (IVIG). We present a case of incomplete KD with IVIG resistance associated with an unusual combination of vesicular guttate-psoriasiform rash, hypertension and late onset small joint arthritis. Case presentation: A four-month-old male infant from Sri Lanka presented with high fever, conjunctival redness, pedal oedema and skin rash. He was found to have hypertension since admission with a high white cell count and high inflammatory markers. There was poor response to intravenous antibiotics and subsequent 2D echocardiogram revealed coronary artery aneurysms suggestive of KD. In the third week of illness he developed a vesiculo-papular rash involving face, trunk and limbs - which on biopsy revealed features of guttate psoriasis. Fever spikes continued and the coronary arteries showed progressive dilatation despite timely intravenous immunoglobulin administered on day 6 and methylprednisolone administered on day 10-13. Therapeutic response by means of reduction of fever was seen only after initiation of intravenous infliximab on day 28 of illness for which the fever responded within 24 hours. He developed a small joint arthritis of hands and feet on day 40 of illness which responded only after initiating methotrexate therapy. The hypertension persisted for 4 months after the onset of the illness before complete resolution. Conclusion: This case report depicts an unusual presentation of KD with a vesicular guttate-psoriasiform eruption, hypertension and late onset small joint arthritis. It highlights that clinicians should be aware of the fact that KD could present with such atypical manifestations and could develop unusual complications.