Aphonia and epiglottitis in neonate with concomitant MRSA skin infection.

We report an unusual case of a neonate with aphonia due to epiglottitis with a concomitant methicillin-resistant S taphylococcus aureus (MRSA) infection of the genitalia and associated septic emboli to the groin area and mouth. We postulate that the MRSA infection caused a transient bacteremia that seeded the epiglottis, likely causing the epiglottitis. In the evaluation of a neonate with aphonia, while the two primary differentials to consider are vocal cord paralysis and laryngeal web, among other considerations is epiglottitis (supraglottitis).

Exogenous Cushing syndrome with inhaled fluticasone in a child receiving lopinavir/ritonavir.

Objective: To describe a case of Cushing syndrome in a child during concurrent use of inhaled fluticasone propionate, nasal mometasone, and a highly active antiretroviral regimen including lopinavir/ritonavir.

Case Summary: A 9-year-old boy with HIV infection and asthma developed moon facies, increased facial hair, and increased weight after fluticasone propionate inhalation (1 puff; 220 microg) therapy was begun. His antiretroviral regimen contained the protease inhibitor combination lopinavir/ritonavir at a dose of 216/54 mg twice daily, and he had been stable for the previous 5 years.

Congenital HIV infection and precocious puberty.

Reported endocrine problems related to human immunodeficiency virus (HIV) infection in children are primarily growth deceleration and delayed pubertal development. We report here an African-American male with congenital HIV infection who developed precocious puberty that was diagnosed at 4-9/12 years of age.

Skin and subcutaneous infections.

Cutaneous infections most commonly are caused by Staphylococcus aureus and GABHS. Life-threatening complications can occur and are preventable with early diagnosis and specific therapy. Dermatophytoses frequently are seen in children and immune-compromised adults with poor hygiene.

Impact of protease inhibitor substitution with efavirenz in HIV-infected children: results of the First Pediatric Switch Study.

Objective: Simplification of antiretroviral regimen in human immunodeficiency virus (HIV)-infected children has not yet been investigated. In general, children have a more difficult time maintaining viral suppression because of many factors, including frequent nonadherence and less availability of antiretrovirals in palatable forms. In addition, many serious metabolic complications have emerged in HIV-infected adults and are believed to be attributable to antiretroviral therapy.