10 0 2
Letters to the Editor
adopted Vietnamese infant. A case of fuhninant disease with recovery, JAMA 230:1561, 1974. Neuman CG, Lawlor G J, Steihm R, et al: Immunologic responses in malnourished children, Am J Clin Nutr 28:98, 1975. Hughes T, Price BA, Sisko F, et al: Protein-calorie malnutrition. A host determinant for Pneumocystis carinii, Am J Dis Child 128:44, 1974.
Thyrotoxicosis in congenital rubella To the Editor: Hyperthyroidism is a rare disease in young children. Since the disorder is extremely uncommon under age 3,' the development of hyperthyroidism in a 3-year-old girl with proved congenital rubella caused us to reflect on a possible etiologic association.
The Journal of Pediatrics December 1975
Observations on this child, and on others with diabetes mellitns, 2 suggest that it may be appropriate to expand the "congenital rubella syndrome" to include certain endocrino_ pathic states. We hope that our description o f this patient may stimulate other investigators to search for similar cases, so that the issue of chance association or causal relationship can be clarified. Evaluation of this patient was initiated when the Rubella Project was a component of the Department o f Pediatrics of the New York University Medical Center-Bellevue Hospital Center. The authors wish to express their gratitude to Dr. Joshua Lynfield for referring the patient for evaluation, and to Drs. Raphael David and Cyril Abrams for consultation regarding the endocrine aspects of this case.
Philip R. Ziring, M.D. Barbara A. Fedun, P.H.N. Louis Z. Cooper, M.D. Rubella Project Pediatric Service The Roosevelt Hospital 428 West 59th St. New York, N. Y. 10019
CASE REPORT
This infant was born to an 18-year-old gravida 2, para 2, serology negative Negro woman after an uncomplicated prep.nancy. The mother had no known exposure to rubella. Birth weight was 5 pounds, 2 ounces, following a gestation o f 38 weeks. During the first week of life, a heart murmur was detected. Evaluation at that time also revealed intrauterine growth retardation, patent ductus arteriosus and ~ulmonary valve stenosis, and bilateral cataracts with microphthalmia. As time progressed, it became evident that the child was deaf and retarded. The rubella HI antibody titer was _> 4,096. Rubella specific IgM HI antibody was present at one month of age and the total serum IgM was elevated to 84 mg/dl. Rubella virus was isolated from a throat swab obtained at one month o f age. At 35 months of age, the child became increasingly irritable and unable to sleep at night. These symptoms were associated with excessive sweating, loss of scalp hair, and an appreciable lid lag. A firm symmetrical mass was palpable in the area o f the thyroid at the base of the neck. Thyroid function studies revealed a T4 of 15.6/~g/dl and T~ of 1,200 ng/dl. Thyroid-stimulating hormone was not detectable. Radioactive iodine uptake was 43% in four hours and 50% in 24 hours. At 5 years, 10 months, after a protracted course of medical management, the child became euthyroid, with normal pulse, absence of goiter, and some regression in degree of exophthalmos.
DISCUSSION Of more than 500 children still in active longitudinal follow-up by the Rubella Project, this is the only case of frank hyperthyroidism to be recognized to date. Fifty other children with congenital rubella and abnormal behavior have been screened for hyperthyroidism. Their serum T4 levels have been within the normal rang e .
The Rubella Project is supported, in part, by The National Foundation-March of Dimes (Grant No. C159), and the Health Research Council of the City o f New York (Contract No. U-2398).
REFERENCES
1. Werner SC, editor: The thyroid, New York, 1962, Harper & Row, Publishers. 2. Forrest JM, and Menser MA: High frequency of diabetes mellitus in young adults with congenital rubella, Lancet 2:332, 1971.
Hypertriglyceridemia in homozygous beta thalassemia To the Editor: Patients with thalassemia major usually have low or normal serum lipids; however, Rama Rao and associates 1 described two patients in whom hypertriglyceridemia was associated with this condition. This association of hypertriglyceridemia and homozygous beta thalassemia may occur more frequently than is suggested by the lack of published reports. CASE REPORT
An ll-month-old female infant was admitted to Reza Pahtavi Medical Center because o f pallor, weakness, and failure to thrive. The parents were nonconsanguineous, the pregnancy was uncomplicated, with delivery at term. The infant was breast fed, and there were no illnesses during infancy. Pallor and weakness were first noticed at age 9 months. Physical examination revealed a very pale infant who was unable to sit. The bodyweight, length, and head circumference were all below the third percentile for these measurements. A systolic murmur Grade II/VI was present; the spleen was just palpable. There was clinical and
Letters to the Editor
adopted Vietnamese infant. A case of fuhninant disease with recovery, JAMA 230:1561, 1974. Neuman CG, Lawlor G J, Steihm R, et al: Immunologic responses in malnourished children, Am J Clin Nutr 28:98, 1975. Hughes T, Price BA, Sisko F, et al: Protein-calorie malnutrition. A host determinant for Pneumocystis carinii, Am J Dis Child 128:44, 1974.
Thyrotoxicosis in congenital rubella To the Editor: Hyperthyroidism is a rare disease in young children. Since the disorder is extremely uncommon under age 3,' the development of hyperthyroidism in a 3-year-old girl with proved congenital rubella caused us to reflect on a possible etiologic association.
The Journal of Pediatrics December 1975
Observations on this child, and on others with diabetes mellitns, 2 suggest that it may be appropriate to expand the "congenital rubella syndrome" to include certain endocrino_ pathic states. We hope that our description o f this patient may stimulate other investigators to search for similar cases, so that the issue of chance association or causal relationship can be clarified. Evaluation of this patient was initiated when the Rubella Project was a component of the Department o f Pediatrics of the New York University Medical Center-Bellevue Hospital Center. The authors wish to express their gratitude to Dr. Joshua Lynfield for referring the patient for evaluation, and to Drs. Raphael David and Cyril Abrams for consultation regarding the endocrine aspects of this case.
Philip R. Ziring, M.D. Barbara A. Fedun, P.H.N. Louis Z. Cooper, M.D. Rubella Project Pediatric Service The Roosevelt Hospital 428 West 59th St. New York, N. Y. 10019
CASE REPORT
This infant was born to an 18-year-old gravida 2, para 2, serology negative Negro woman after an uncomplicated prep.nancy. The mother had no known exposure to rubella. Birth weight was 5 pounds, 2 ounces, following a gestation o f 38 weeks. During the first week of life, a heart murmur was detected. Evaluation at that time also revealed intrauterine growth retardation, patent ductus arteriosus and ~ulmonary valve stenosis, and bilateral cataracts with microphthalmia. As time progressed, it became evident that the child was deaf and retarded. The rubella HI antibody titer was _> 4,096. Rubella specific IgM HI antibody was present at one month of age and the total serum IgM was elevated to 84 mg/dl. Rubella virus was isolated from a throat swab obtained at one month o f age. At 35 months of age, the child became increasingly irritable and unable to sleep at night. These symptoms were associated with excessive sweating, loss of scalp hair, and an appreciable lid lag. A firm symmetrical mass was palpable in the area o f the thyroid at the base of the neck. Thyroid function studies revealed a T4 of 15.6/~g/dl and T~ of 1,200 ng/dl. Thyroid-stimulating hormone was not detectable. Radioactive iodine uptake was 43% in four hours and 50% in 24 hours. At 5 years, 10 months, after a protracted course of medical management, the child became euthyroid, with normal pulse, absence of goiter, and some regression in degree of exophthalmos.
DISCUSSION Of more than 500 children still in active longitudinal follow-up by the Rubella Project, this is the only case of frank hyperthyroidism to be recognized to date. Fifty other children with congenital rubella and abnormal behavior have been screened for hyperthyroidism. Their serum T4 levels have been within the normal rang e .
The Rubella Project is supported, in part, by The National Foundation-March of Dimes (Grant No. C159), and the Health Research Council of the City o f New York (Contract No. U-2398).
REFERENCES
1. Werner SC, editor: The thyroid, New York, 1962, Harper & Row, Publishers. 2. Forrest JM, and Menser MA: High frequency of diabetes mellitus in young adults with congenital rubella, Lancet 2:332, 1971.
Hypertriglyceridemia in homozygous beta thalassemia To the Editor: Patients with thalassemia major usually have low or normal serum lipids; however, Rama Rao and associates 1 described two patients in whom hypertriglyceridemia was associated with this condition. This association of hypertriglyceridemia and homozygous beta thalassemia may occur more frequently than is suggested by the lack of published reports. CASE REPORT
An ll-month-old female infant was admitted to Reza Pahtavi Medical Center because o f pallor, weakness, and failure to thrive. The parents were nonconsanguineous, the pregnancy was uncomplicated, with delivery at term. The infant was breast fed, and there were no illnesses during infancy. Pallor and weakness were first noticed at age 9 months. Physical examination revealed a very pale infant who was unable to sit. The bodyweight, length, and head circumference were all below the third percentile for these measurements. A systolic murmur Grade II/VI was present; the spleen was just palpable. There was clinical and
