Hydatid cyst of head of pancreas mimicking choledochal cyst.

A 5-year-old girl presented with abdominal pain, intermittent jaundice and a gall bladder lump. Clinical examination and preoperative imaging suggested the diagnosis of a type I choledochal cyst (CDC). During surgery, this was found to be a hydatid cyst (HC) occupying the head of pancreas causing obstruction to the common bile duct (CBD).

Kocher-Debre-Semelaigne syndrome.

A 4-year-old male child presented with severe growth failure and developmental delay. He had hypertrophy of calf muscles and the thyroid profile showed low levels of T3, T4 and markedly elevated level of thyroid-stimulating hormone thus confirming the presence of hypothyroidism. This combination of hypothyroidism and hypertrophy of muscles is classically described as Kocher-Debré-Semelaigne syndrome.

Pyoderma gangrenosum.

A 3.5-year-old girl presented with skin lesions beginning as a small pustule that progressed to very painful large ulcer with rolled up edges and irregular borders. At presentation, active ulcers were present over the left elbow.

Cleft palate, arachnoid cyst and posterior urethral valve.

A 5-month-old infant presented with cleft palate, febrile urinary tract infection and abnormal movements. His urinary stream was poor and investigations revealed posterior urethral valve and grade V vesicoureteric reflux. This baby was investigated for seizure activity and on MRI of the brain was found to have a large arachnoid cyst, splaying the occipital horns and compressing the posterior aspect of third ventricle leading to dilatation of the ventricles.

Patent vitellointestinal duct.

During the 3rd week of intrauterine life there is a communication between the intraembryonic gut and the yolk sac. As the development proceeds this communication narrows into a tube known as the vitellointestinal duct (VID). With the establishment of placental nutrition this duct usually becomes obliterated by the end of the 7th week of intrauterine life.

Renal tubular acidosis and superior mesenteric artery syndrome.

A 12-year-old girl presented with significant vomiting, and generalised muscular weakness. She had normal anion gap metabolic acidosis, hypokalemia and alkaline urine. Vomiting generally leads to metabolic alkalosis but this patient had acidosis which suggested either renal tubular acidosis (RTA) or diarrhoea.

Neuro-regression in vitamin B12 deficiency.

Neuroregression in infants has varied aetiology and vitamin B12 deficiency is one of the uncommon causes. Infantile vitamin B12 deficiency is encountered in malnourished infants or in offspring of strict vegan mothers. We present two cases, both infants of 10 and 8 months of age, whose mothers had vitamin B12 deficiency.