Browsing by Author "Leung, Alexander K. C."
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- ItemOpen AccessA Case of Congenital Syphilis Presenting with Unusual Skin Eruptions(2018-03-25) Leung, Alexander K. C.; Leong, Kin Fon; Lam, Joseph M.Once believed to be a rare disease in developed countries, recent data suggest that there is a surge in incidence of congenital syphilis in many developed countries. Diagnosis of congenital syphilis can be difficult because more than two-thirds of affected infants are asymptomatic at birth, and signs of symptomatic infants may be nonspecific or subtle. On top of this, some affected infants may have atypical presentations. Familiarity with the diverse presentations is essential to diagnosis. We report a 2-week-old male infant with congenital syphilis whose cutaneous manifestations included diffuse, erythematous keratoderma with desquamation and fissures on his hands and feet, multiple linear scaly fissures at the angles of his mouth, and onychauxis of the fingernails and toenails To our knowledge, diffuse, erythematous keratoderma of the hands and feet and thick nails have not been reported previously in congenital syphilis.
- ItemOpen AccessA Case of Dilated Cardiomyopathy Associated with 3-Hydroxy-3-Methylglutaryl-Coenzyme A (HMG CoA) Lyase Deficiency(2009-11-04) Leung, Alexander A. C.; Chan, Alicia K.; Ezekowitz, Justin A.; Leung, Alexander K. C.3-hydroxy-3-methylglutaryl-coenzyme A (HMG CoA) lyase deficiency is an inborn error of metabolism characterized by impairment of ketogenesis and leucine catabolism resulting in an organic acidopathy. In 1994, a case of dilated cardiomyopathy and fatal arrhythmia was reported in a 7-month-old infant. We report a case of dilated cardiomyopathy in association with HMG CoA lyase deficiency in a 23-year-old man with the acute presentation of heart failure. To our knowledge, this is the first case reported in an adult.
- ItemOpen AccessAn 8-Year-Old Child with Delayed Diagnosis of Netherton Syndrome(2018-01-30) Leung, Alexander K. C.; Barankin, Benjamin; Leong, Kin FonWe report an 8-year-old boy with Netherton syndrome who was misdiagnosed and treated as severe atopic dermatitis. The diagnosis of Netherton syndrome was not made until the child was 8 years of age. We discuss the pitfalls in the diagnosis and alert physicians to the proper and early diagnosis of this syndrome. The child was treated with a low dose (0.25 mg/kg) of oral acitretin and a topical moisturizer with marked improvement of his skin and pruritus in 2 months. At 6-month follow-up, the skin was almost clear of erythema and scaling, and the hair was longer and stronger. The dose of acitretin was reduced to 0.12 mg/kg for another 6 months and then discontinued.
- ItemOpen AccessBe Careful, Mom and Doc: Hepatotoxicity Associated with Prescribed Medications in Young Infants(2009-04-14) Hon, Kam-Lun Ellis; Leung, Alexander K. C.Accidental poisonings in young infants are relatively uncommon, and the careless caregiver is usually the culprit. We report two cases of hepatotoxicity due to prescribed medications. An infant was given 15 mL instead of 1.5 mL of paracetamol by his mother because she omitted the decimal point on the label of the drug bottle. The infant became symptomatic, and liver enzyme and clotting profile were abnormal, necessitating treatment with N-acetyl cysteine. Another infant was prescribed oral ketoconazole for thrush, resulting in elevation of liver enzymes. The serum alanine aminotransferase levels were transiently elevated but returned to normal, and both infants recovered uneventfully. This report serves to alert the doctor to avoid using decimal points in drug labeling and to avoid prescribing excessive amount of drug for trivial acute illness. Thrush in infancy is common and usually treated with oral nystatin. Other oral antifungals such as ketoconazole may be associated with liver derangement and should be avoided in infants.
- ItemOpen AccessBilateral Symmetrical Herpes Zoster in an Immunocompetent 15-Year-Old Adolescent Boy(2015-01-27) Leung, Alexander K. C.; Barankin, BenjaminHerpes zoster is uncommon in immunocompetent children. The bilateral symmetrical occurrence of herpes zoster lesions is extremely rare. We report a 15-year-old immunocompetent Chinese adolescent boy who developed bilateral symmetrical herpes zoster lesions. To our knowledge, the occurrence of bilateral symmetrical herpes zoster lesions in an immunocompetent individual has not been reported in the pediatric literature.
- ItemOpen AccessCentral Hypoventilation: A Case Study of Issues Associated with Travel Medicine and Respiratory Infection(2015-07-29) Hon, Kam Lun; Leung, Alexander K. C.; Li, Albert M. C.; Ng, Daniel K. K.Aim. We presented the case of a child with central hypoventilation syndrome (CHS) to highlight issues that need to be considered in planning long-haul flight and problems that may arise during the flight. Case. The pediatric intensive care unit (PICU) received a child with central hypoventilation syndrome (Ondine’s curse) on nocturnal ventilatory support who travelled to Hong Kong on a make-a-wish journey. He was diagnosed with central hypoventilation and had been well managed in Canada. During a long-haul aviation travel, he developed respiratory symptoms and desaturations. The child arrived in Hong Kong and his respiratory symptoms persisted. He was taken to a PICU for management. The child remained well and investigations revealed no pathogen to account for his respiratory infection. He went on with his make-a-wish journey. Conclusions. Various issues of travel medicine such as equipment, airline arrangement, in-flight ventilatory support, travel insurance, and respiratory infection are explored and discussed. This case illustrates that long-haul air travel is possible for children with respiratory compromise if anticipatory preparation is timely arranged.
- ItemOpen AccessComplications of Bezoar in Children: What Is New?(2013-10-29) Lun Ellis Hon, Kam; Cheng, Jean; Chow, Chung Mo; Ming Cheung, Hon; Cheung, Kam Lau; Tam, Yuk Him; Leung, Alexander K. C.A bezoar is a mass found trapped in the gastrointestinal system. The condition may be associated with pica, especially in developmentally retarded children. Clinical manifestations are usually nonspecific. Endoscopic diagnosis and removal of the foreign materials is often indicated. Occasionally, severe complications may occur. We report two cases to illustrate the clinical features and complications in these children. In the first case, a reliable history was not obtained in the developmentally delayed girl which precluded prompt diagnosis, but the grossly dilated stomach on plain abdominal radiograph gave clues to an underlying insidious mechanical obstruction of upper gastrointestinal tract. In the second case of a normal child, the unrelenting symptoms and weight loss prompt further investigations which revealed the diagnosis. Literature on pediatric bezoar is reviewed. Oesophagoduodenoscopy is the investigation of choice for diagnostic confirmation, but surgical facilities must be available to deal with acute complications.
- ItemOpen AccessCupping Therapy May be Harmful for Eczema: A PubMed Search(2013-10-27) Hon, Kam Lun E.; Luk, David Chi Kong; Leong, Kin Fon; Leung, Alexander K. C.Eczema is a common childhood atopic condition and treatment is with emollients, topical corticosteroids, and avoidance of possible triggers. S. aureus colonization is a common complication. As there is no immediate cure, many parents seek alternative therapies that claim unproven therapeutic efficacy. We report a girl with long history of treatment noncompliance. After practicing a long period of dietary avoidance and supplementation, the grandparents took her to an alternative medicine practitioner. Following cupping therapy and acupuncture, the child developed blistering and oozing over her back the next day, which rapidly evolved to two large irregular-edge deep ulcers. She was treated with intravenous antibiotics and received multidisciplinary supportive intervention. Using search words of “cupping,” “eczema,” and “atopic dermatitis,” only two reports were found on PubMed. Therapeutic efficacy was claimed but not scientifically documented in these reports. Childhood eczema is an eminently treatable atopic disease. Extreme alternative therapy seems not to be efficacious and may even be associated with serious undesirable sequelae. Physicians should be aware of various alternative treatment modalities and be prepared to offer evidence-based advice to the patients with eczema and their families.
- ItemOpen AccessDelayed Presentation of Congenital Diaphragmatic Hernia with Acute Respiratory Distress: Challenges in Diagnosis and Management(2020-07-26) Hon, Kam Lun; Fung, Ronald C. M.; Leung, Alexander K. C.Delayed presentation of congenital diaphragmatic hernia (CDH) with acute respiratory distress beyond the newborn period may poise challenges in diagnosis and management. We report a 3-month-old infant who presented with acute-onset respiratory distress and left congenital diaphragmatic hernia that was relieved with thoracoscopic repair. CDH must be differentiated from pneumothorax or pulmonary cyst. Erroneous diagnosis and treatment with thoracocentesis could be disastrous. Pediatricians and surgeons must be aware of this condition to allow early diagnosis and expeditious management. Subcutaneous emphysema should not be misdiagnosed as pneumothorax and management is expectant.
- ItemOpen AccessErythema Dyschromicum Perstans in an 8-Year-Old Indian Child(2018-07-15) Leung, Alexander K. C.; Lam, Joseph M.We report an 8-year-old East Indian boy with erythema dyschromicum perstans. The condition has very rarely been reported in prepubertal Indian children. A perusal of the literature revealed but two cases, to which we add another one. Recognition of erythema dyschromicum perstans in prepubertal Indian children is important for proper diagnosis and to prevent unnecessary investigations.
- ItemOpen AccessExtensive Aplasia Cutis Congenita Encircling the Trunk Associated with Fetus Papyraceus(2020-08-28) Leung, Alexander K. C.; Leong, Kin Fon; Lam, Joseph M.Aplasia cutis congenita associated with fetus papyraceus, though rare, is well known. On the other hand, aplasia cutis congenita associated with fetus papyraceus presenting with symmetrical circumferential scarring encircling the trunk has not been previously reported. Herein, we report a 2-month-old girl with symmetrical circumferential scarring encircling the trunk associated with fetus papyraceus.
- ItemOpen AccessGeneralized Lichen Nitidus in Identical Twins(2012-11-22) Leung, Alexander K. C.; Ng, JeffreyLichen nitidus is an uncommon idiopathic chronic dermatosis characterized by minute, flesh-colored or hypopigmented, shiny papules commonly occurring on the abdomen, chest, genitalia, and extremities. The disorder is most often localized but, rarely, can become extensive or generalized. The occurrence of lichen nitidus during infancy is extremely rare. A perusal of the English literature revealed but two cases. We report two identical twins with lesions of generalized lichen nitidus noted at two months of age. The familial occurrence of lichen nitidus suggests that a genetic factor may be operative.
- ItemOpen AccessLate Onset Streptococcus agalactiae Meningitis following Early Onset Septicemia: A Preventable Disease?(2017-10-01) Hon, Kam Lun; Chan, King Hang; Ko, Pak Long; So, King Woon; Leung, Alexander K. C.We report a neonate who presented with early onset Streptococcus agalactiae or group B streptococcus (GBS) septicemia within 24 hours of birth. After discharge at day 14, she went on to develop late onset GBS meningitis at 36 days of age. The infant was treated with intravenous antibiotics on both occasions and eventually discharged home with no apparent sequelae. We address issues associated with GBS infection in infancy including the demographics, risk factors, and the risk of late onset GBS meningitis following an early onset GBS infection. The major source of GBS in early onset GBS disease is maternal birth canal GBS colonization. On the other hand, nosocomial cross-infection is an important source of GBS in late onset disease. Penicillin remains the current treatment of choice for GBS infection. Given the rapid onset and progression within hours of birth and lack of an effective solution for preventing late onset GBS, administration of an effective GBS vaccine in pregnancy could provide a sensible and cost-effective solution in all settings.
- ItemOpen AccessLaugier–Hunziker Syndrome in an 8-Year-Old Boy with Scleral Melanocytosis, Lingual Pigmentation, Labial Pigmentation, and Melanonychia Striata(2020-03-17) Leung, Alexander K. C.; Leong, Kin Fon; Barankin, Benjamin; Lam, Joseph M.Laugier–Hunziker syndrome is a rare, acquired disorder characterized by mucocutaneous hyperpigmentation and melanonychia striata with no underlying systemic abnormalities. We report an 8-year-old boy with Laugier–Hunziker syndrome who presented with melanonychia striata affecting all the fingernails and toenails, macular pigmentation on the tongue and the lower lip, and scleral melanocytosis. Melanonychia striata rarely affect all the twenty nails, and scleral melanocytosis has rarely been reported in association with Laugier–Hunziker syndrome. Laugier–Hunziker syndrome occurs predominately in adults. Our patient is the youngest reported patient with Laugier–Hunziker syndrome.
- ItemOpen AccessLichen Striatus with Nail Involvement in a 6-Year-Old Boy(2020-01-27) Leung, Alexander K. C.; Leong, Kin Fon; Barankin, BenjaminWe describe a 6-year-old boy with an asymptomatic linear eruption on the left index finger with mild erythema of the proximal nail fold, nail dystrophy, and subungual hyperkeratosis of the nail. A diagnosis of nail lichen striatus was made. The child was successfully treated with a topical corticosteroid. Because of its rarity, nail lichen striatus is often under-recognized. Physicians should be familiar with the nail involvement in individuals with lichen striatus so that an accurate diagnosis can be made and unnecessary investigations and treatment avoided.
- ItemOpen AccessLocalized Acquired Hypertrichosis Associated with the Application of a Splint(2012-03-26) Leung, Alexander K. C.; Wong, Andrew S.We describe a 16-year-old boy whose left forearm and hand were cut by a piece of glass from a broken window as a result of the fall. He had surgical repair of his left extensor pollicis brevis, abductor pollicis brevis, and dorsal branch of the left radial nerve. Following the surgery, he was put on a splint so as to immobilize the left forearm and wrist. On removal of the splint 4 weeks post surgery, he was noticed to have more hair growth on his left forearm and hand than his right counterparts. The patient was reassessed 2, 4, and 8 months after the removal of the splint. The hypertrichosis got better with time. At the last visit, the hair growth in the left forearm and hand was back to normal. Our patient represents the first reported case of localized acquired hypertrichosis following the application of a splint in the pediatric literature.
- ItemOpen AccessMagnetic Foreign Body Ingestion in Children: The Attractive Hazards(2019-04-28) Lin, Anna; Chan, Lawrence Chi Ngong; Hon, Kam Lun Ellis; Tsui, Siu Yan Bess; Pang, Kristine Kit Yi; Cheung, Hon Ming; Leung, Alexander K. C.Foreign body ingestions are frequent in the childhood population. Most foreign bodies are passed spontaneously through the gastrointestinal tract. However, on occasion, they can also be a rare cause of morbidity and even mortality, such as in the case of multiple magnetic foreign body ingestion, which can cause injury via magnetic attraction through bowel walls. We present two cases of multiple magnetic foreign body ingestion, which to our knowledge are the first ones reported in Hong Kong. One patient presented with shock and intestinal necrosis requiring extensive intestinal resection, whereas the other patient had no gastrointestinal injury but surgical removal was deemed necessary.
- ItemOpen AccessNeonatal Abdominal Hemangiomatosis: Propranolol beyond Infantile Hemangioma(2016-03-27) Nip, Siu Ying Angel; Hon, Kam Lun; Leung, Wing Kwan Alex; Leung, Alexander K. C.; Choi, Paul C. L.Hemangioma is the most common vascular tumor of infancy; presentation is often as cutaneous infantile hemangioma (IH). Cutaneous hemangioma is a clinical diagnosis. Most IHs follow a benign course, with complete involution without treatment in the majority of cases. Visceral hemangioma often involves the liver and manifests as a life-threatening disorder. Hepatic hemangiomas may be associated with high output cardiac failure, coagulopathy, and hepatomegaly which generally develop between 1 and 16 weeks of age. Mortality has been reportedly high without treatment. We report a rare case of a male infant with neonatal hemangiomatosis with diffuse peritoneal involvement, which mimicked a malignant-looking tumor on imaging, and discuss therapeutic options and efficacy. Propranolol is efficacious for IH but generally not useful for other forms of vascular hemangiomas, tumors, and malformations. In our case of neonatal peritoneal hemangiomatosis, propranolol appears to have halted the growth and possibly expedite the involution of the hemangiomatosis without other treatments.
- ItemOpen AccessNevus Lipomatosus Superficialis on the Left Proximal Arm(2017-09-13) Leung, Alexander K. C.; Barankin, BenjaminWe report a 58-year-old woman with a solitary type of nevus lipomatosus superficialis on the left proximal arm. To our knowledge, the occurrence of a solitary type of nevus lipomatosus superficialis on the arm has very rarely been reported. A perusal of the literature revealed but one case, to which we are going to add another one. Recognition of this clinical manifestation is important so that a proper diagnosis can be made.
- ItemOpen AccessNew Concepts in Median Nail Dystrophy, Onychomycosis, and Hand, Foot, and Mouth Disease Nail Pathology(2012-01-26) Hoy, Nathan Y.; Leung, Alexander K. C.; Metelitsa, Andrei I.; Adams, StewartNails are underutilized as diagnostic tools, despite being involved in many dermatologic conditions. This paper explores new concepts in the treatment of median nail dystrophy (MND), onychomycosis, and the nail pathology of hand, foot, and mouth disease (HFMD). A Pubmed database literature search was conducted for MND treatment, onychomycosis treatment, and HFMD nail pathology. Only papers published after January 2008 were reviewed. The results showed that 0.1% tacrolimus ointment can be an effective treatment for MND. Early studies on laser therapy indicate that it is a safe and efficacious treatment option for onychomycosis, compared to conventional oral antifungal agents. Vicks VapoRub (The Proctor & Gamble Company, Cincinnati, OH) is effective against onychomycosis and is a reasonable option in patients who choose to forgo conventional treatments. Lastly, there is evidence to support a correlation between HFMD and onychomadesis.