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Carbamate and organophosphate pesticides are widely used all over the world. Poisoning with these substances may produce both immediate and delayed neurotoxic effects. We report the case of a 4-year-old boy who was admitted to the Pediatric Department of the Second University of Naples for evaluation of stupor, lethargy, severe hypotonia, generalized weakness of his arms and legs, ataxia, dysmetria, miosis, excessive salivation and tearing. The pesticide carbaryl (1-naphthyl-N-methyicarbamate) was identified in blood and urine samples. On admission, magnetic resonance imaging (MRI) was unremarkable; on day 11, MRI showed central pontine myelinolysis. The demyelination improved after 4 months and disappeared after 2 years. Various underlying and concomitant diseases have been described in children with central pontine myelinolysis but, to our knowledge, the finding of pontine myelinolysis after carbamate poisoning has not yet been described. Keywords Pontine myelinolysis; Carbamate; Poisoning; Children, CASE REPORT A 4-year-old boy was admitted to the Pediatric Department of the Second University of Naples for evaluatation of lethargy and muscle weakness. The family history was unremarkable. No [...]

In macroamylasemia, a macromolecular complex consisting of amylase linked to immunoglobulins circulates in the plasma and usually causes benign hyperamylasemia with low or normal amylasuria. Macroamylasemia is extremely rare in pediatric patients as it has been described in only four patients. We report herein the case of a 5-year-old girl with abdominal pain and macroamylasemia. To recognize macroamylase, we used agar gel electrophoresis, PEG precipitation, and fast protein liquid chromatography (FPLC). In our case, FPLC was found to be the most reliable method for the identification of the macromolecular complex. Macroamylasemia is merely a biochemical abnormality that is not associated with any kind of pathology. Its identification is therefore essential in order to avoid a wrong diagnosis, i.e., pancreatitis, with consequent inappropriate therapies.

Sir.—In the clinical memorandum "Cushing's Syndrome After Topical Application of Corticosteroids" (Journal 1982;136:274-275), Ruiz-Maldonado et al reported a case of Cushing's syndrome that was induced by topically applied corticosteroids (betamethasone valerate) in an infant. The following case report is a further example of systemic effects caused by misprescription of corticosteroid-containing creams.Report of a Case.—A male infant aged 4 months 15 days was treated from the age of 15 days with topically applied high-potency corticosteroids (clobetasol propionate, 40 tubes each containing 15 mg of active substance) for a diaper dermatitis that was complicated by cutaneous candidiasis. At 4 months of age, he was referred to a pediatric hospital for the persistence of cutaneous lesions and the presence of clinical features suggestive of Cushing's syndrome. After the topical steroid treatment was discontinued, the patient had symptoms of adrenal insufficiency (pallor, vomiting, hypotension, and tachycardia) that regressed after parenteral administration