Children with Down syndrome have a higher risk of stroke. Similarly, intravenous immunoglobulin (IV Ig) is also known to cause a stroke. We reported a 3-year-old boy with Down syndrome who presented with severe pneumonia and received IV Ig. He developed right hemiparesis 60 hours after the infusion. Blood investigations, echocardiography and carotid Doppler did not suggest vasculitis, thrombophilia or extracranial dissection. Brain computerised tomography (CT) showed acute left frontal and parietal infarcts. Initial magnetic resonance angiography (MRA) of cerebral vessels showed short segment attenuations of both proximal middle cerebral arteries and reduction in the calibre of bilateral supraclinoid internal carotid arteries. The boy was treated with enoxaparin and aspirin. He only had partial recovery of the hemiparesis on follow-up. A repeat MRA 13 months later showed parenchymal collateral vessels suggestive of moyamoya disease. We recommend imaging the cerebral vessels in children with a high risk of moyamoya before giving IV Ig.
Elizabethkingia species are multi-drug resistant, Gram-negative bacteria that can adapt to different environmental conditions and rarely cause infections in humans but can be fatal among immunocompromised populations. We report our first experience of managing 2 pediatric patients infected with Elizabethkingia species. Over 12-months, 2 pediatric patients were infected with Elizabethkingia species in our hospital. They were both immunocompromised and were initially covered with broad spectrum antibiotics. Their conditions deteriorated and further investigations revealed the growth of Elizabethkingia species from the blood culture. Change of antibiotics was commenced and marked improvement was shown along the course of treatment. Both eventually completed the treatments and recovered remarkably well with no complications from the infections. However, colonization of the Elizabethkingia species was not identified on our environmental surveillance. Timely and appropriate anti-infectives and supportive management have shown marked improvement and disease curability in our patients who suffered from bacteremia and multiple liver abscesses.