1/2. Autoimmune hepatitis associated with the odour of fish food proteins: a causal relationship or just a mere association?We present the case of a 15-year-old boy [HLA phenotype: A 1, 25 (10); B 18, 8; C 7; DR 17 (3), 6] with classic (type 1) autoimmune hepatitis presumably caused by a long-term exposure to the strong odour of food fed to a large number of tropical fish which that the boy kept in tanks in his bedroom. The boy presented with a history of recent symptoms of common cold, and a high cytomegalovirus-IgG titer, both known to activate proinflammatory cytokines. The patient's laboratory results and physical findings improved without specific treatment during his first stay in the hospital for several weeks, as well as when the thanks were removed from his bedroom while disease activity increased after his return home. This suggests that the association with fish food odour (putative volatile protein antigens) was not simply coincidental. Our patien's history is in agreement with the recently postulated pathomechanism of autoimmune hepatitis, according to which viral infections may trigger the disease in a genetically predisposed individuals persistently exposed to a constant antigenic stimulus, which results in ongoing allergic inflammation and finally develops into an immune process. The spontaneous remissions observed in our patient were characteristic of the natural course of autoimmune hepatitis and may reflect periods when he was not exposed to the eventually harmful effects of the odour of fish food proteins.- - - - - - - - - - ranking = 1keywords = physical (Clic here for more details about this article) |
2/2. Evaluation of persistent cough in children.Persistent or chronic cough is defined as a cough lasting more than 3 weeks. A systematic approach to the diagnosis and treatment of chronic cough involves a detailed history. The age of the child, descriptive qualities of the cough, and environmental exposures are particularly important. A thorough physical examination, looking for evidence of growth retardation and failure to thrive in addition to more specific signs, is essential. When further investigation is necessary, a complete blood count, chest radiograph, and PPD are indicated. Additional testing is guided by findings in the history and physical examination to rule out the less common but more serious causes.- - - - - - - - - - ranking = 2keywords = physical (Clic here for more details about this article) |