hospitalised and managed with atosiban IV, and two doses of betamethasone intramuscularly were given at 30 weeks of ges- tation. Caesarean section was ...
doi:10.1111/jpc.13870
IMAGES OF THE MONTH
Recurrent erythema and hyperpigmentation Question A 6-year-old twin boy whose elder brother has Crohn’s disease developed recurrent erythema for the past 1 year over the chin and neck region soon after developing fever and consuming paracetamol. The erythematous patch became hyperpigmented within the same day (Fig. 1). Soon, the child developed more patches over the abdomen, back, upper limbs and thigh. What is the diagnosis? (Answer on page 458) Dr Su Yuen Ng Dr Sze Yee Chong Department of Paediatrics Hospital Raja Permaisuri Bainun Ipoh Malaysia Fig. 1 Hyperpigmented patches over the chin and neck.
A ventilated newborn with respiratory distress, abdominal distension and scrotal swelling Question The spontaneous monochorionic diamniotic twin pregnancy of a 39-year-old woman was complicated by intra-uterine growth restriction (IUGR) in one of the twins. Amniocentesis performed in both sacs revealed a normal 46XX and an IUGR 46XY fetus. Due to premature contractions, the mother was hospitalised and managed with atosiban IV, and two doses of betamethasone intramuscularly were given at 30 weeks of gestation. Caesarean section was performed at 31 weeks because of the severe compromise of the IUGR twin, which was associated with reverse end-diastolic flow in the umbilical artery, decreased mean cerebral artery pulsatility index and increased pulsatility index of the ductus venosus associated with a positive wave. The 1260 g male infant had low Apgar scores and was transferred to the Neonatal Unit on nasal continuous positive airway pressure (CPAP). Due to increased work of breathing and the radiographic evidence of respiratory distress syndrome, the patient was intubated and mechanically ventilated, and two doses of surfactant were administered. After accidental
extubation, he was reset on nasal CPAP but was subsequently re-intubated due to respiratory compromise. Shortly after, profound desaturation, abdominal distension and scrotal engorgement occurred. The scrotum was swollen, and palpable crepitus was present. What are the findings of the chest and abdominal radiograph of the neonate? What pathological conditions are shown by the arrows, and what is their pathogenesis? (Answer on page 458) Professor Xenophon Sinopidis1 Professor Sotirios Fouzas2 Professor Gabriel Dimitriou2 Professor Ageliki Karatza 2 1 Department of Paediatric Surgery, and 2Neonatal Intensive Care Unit, Department of Paediatrics University General Hospital Patras Greece Conflict of interest: None declared.
