RESUMEN
The authors report a 12-mo-old girl with calcified cerebral cryptococcal granuloma. She was admitted with a 6-mo history of seizures. Laboratory examinations showed no abnormal findings. Electroencephalography revealed bilateral slow wave activity, greater in the right occipital region. CT showed an irregular calcified focus with small surrounding low density in the right parieto-occipital region. MRI demonstrated mixed signals without edema and visible flow-voids. The clinical symptoms mimicked intracranial vascular malformations. The diagnosis of cerebral cryptococcal granuloma was made by histopathology. Partial resection of the lesion with post-operatively antifungal and anticonvulsant therapy offered the satisfactory result. Cerebral cryptococcal granuloma is extremely rare, especially in infants. Calcification is indeed unusual. Cerebral cryptococcal granuloma should be included in the differential diagnosis of intracranial mass with calcification in infants.
Asunto(s)
Encefalopatías/diagnóstico , Calcinosis/diagnóstico , Cryptococcus , Granuloma Eosinófilo/diagnóstico , Lóbulo Parietal/diagnóstico por imagen , Lóbulo Parietal/patología , Encefalopatías/complicaciones , Encefalopatías/microbiología , Encefalopatías/cirugía , Calcinosis/complicaciones , Calcinosis/cirugía , Preescolar , Cryptococcus/aislamiento & purificación , Diagnóstico Diferencial , Electroencefalografía , Granuloma Eosinófilo/complicaciones , Granuloma Eosinófilo/microbiología , Granuloma Eosinófilo/cirugía , Femenino , Humanos , Imagen por Resonancia Magnética , Procedimientos Neuroquirúrgicos/métodos , Lóbulo Parietal/cirugía , Readmisión del Paciente , Convulsiones/etiología , Tomografía Computarizada por Rayos X , Resultado del TratamientoRESUMEN
AIM: To establish a population pharmacokinetics (PPK) model for lamotrigine (LTG) in Chinese children with epilepsy in order to formulate an individualized dosage guideline. METHODS: LTG steady-state plasma concentration data from therapeutic drug monitoring (TDM) were collected retrospectively from 284 patients, with a total of 404 plasma drug concentrations. LTG concentrations were determined using a HPLC method. The patients were divided into 2 groups: PPK model group (n=116) and PPK valid group (n=168). A PPK model of LTG was established with NONMEM based on the data from PPK model group according to a one-compartment model with first order absorption and elimination. To validate the basic and final model, the plasma drug concentrations of the patients in PPK model group and PPK valid group were predicted by the two models. RESULTS: The final regression model for LTG was as follows: CL (L/h)=1.01*(TBW/27.87)(0.635)*e(-0.753*VPA)*e(0.868*CBZ)*e(0.633*PB), Vd (L)= 16.7*(TBW/27.87). The final PPK model was demonstrated to be stable and effective in the prediction of serum LTG concentrations by an internal and external approach validation. CONCLUSION: A PPK model of LTG in Chinese children with epilepsy was successfully established with NONMEM. LTG concentrations can be predicted accurately by this model. The model may be very useful for establishing initial LTG dosage guidelines.
Asunto(s)
Anticonvulsivantes/farmacocinética , Epilepsia/tratamiento farmacológico , Modelos Biológicos , Triazinas/farmacocinética , Adolescente , Anticonvulsivantes/administración & dosificación , Anticonvulsivantes/uso terapéutico , Pueblo Asiatico , Niño , Preescolar , China , Cromatografía Líquida de Alta Presión , Relación Dosis-Respuesta a Droga , Monitoreo de Drogas/métodos , Femenino , Humanos , Lactante , Lamotrigina , Masculino , Dinámicas no Lineales , Guías de Práctica Clínica como Asunto , Análisis de Regresión , Estudios Retrospectivos , Triazinas/administración & dosificación , Triazinas/uso terapéuticoRESUMEN
BACKGROUND: Multiple calcified primary central nervous system lymphoma (PCNSL) is extremely rare in childhood. METHODS: We report a 4-year-old boy suffering from multiple calcified B-cell lymphoma in the brain with immunodeficiency. RESULTS: The boy had a history of walking weakness and seizure for 4 months. The serum levels of immunoglobulin G, A and M were decreased. Brain MRI showed multiple lesions which had ring enhancement. CT showed calcification in all of the lesions. The boy was firstly misdiagnosed with multiple chronic brain abscesses. Pathological analysis of biopsy confirmed the diagnosis of anaplastic diffuse large B-cell lymphoma. CONCLUSION: PCNSL should be included in the differential diagnosis of intracranial mass with calcification.