An 8-year-old girl with chronic immune thrombocytopenic purpura treated with eltrombopag presented with lactic acidosis and severe hyperammonemic encephalopathy necessitating hemofiltration. Genetic metabolic disorders associated with hyperammonemia were excluded. Despite standard dosing, supratherapeutic plasma levels of eltrombopag were found, suggesting an adverse drug effect due to drug accumulation. Awareness of hyperammonemia as adverse reaction to eltrombopag is warranted. Close monitoring of transaminases is required in children and therapeutic drug monitoring could aid in tailoring effective treatment doses for children to mitigate risk in populations that are more susceptible to complications.

Cryptorchidism ; diagnosis ; Hernia, Inguinal ; diagnosis ; Humans ; Infant ; Male ; Scrotum ; pathology ; Ultrasonography

It is crucial to realize that both omental infarction and acute appendicitis can occur simultaneously in the children as both diseases are managed differently. Omental infarction itself is rare in the pediatric group, and its association with acute appendicitis is even rarer. Both diseases usually present with right sided abdominal pain. Ultrasound is the choice of imaging modality in the investigation of abdominal pain in the children. It should not be content if omental infarction is detected, whilst the normal appendix is not seen. We reported a case of simultaneous omental infarction and acute appendicitis in a child who presented with 3 days history of right sided abdominal pain. It was diagnosed preoperatively by ultrasound. Prompt surgical intervention was proceeded and the child made uneventful recovery.
Appendicitis ; Infarction

“Enlarged parietal foramina” is a congenital malformation with autosomal dominant inheritance. The condition is usually self-limiting and doesn’t require any treatment. However, it may also be associated with encephalocele, vascular anomalies or may be a part of syndrome. We present a case of enlarged parietal foramina in a child and discuss its imaging findings and the associated intracranial vascular malformations.
Encephalocele

Appendectomy ; adverse effects ; Appendicitis ; surgery ; Diagnosis, Differential ; Hernia, Abdominal ; diagnosis ; etiology ; surgery ; Herniorrhaphy ; methods ; Humans ; Male ; Radiography, Abdominal ; Tomography, X-Ray Computed ; Young Adult