Background: Double aneuploidy is the phenomenon where two aneuploidies co-exist in the same individual, usually involving one autosomal chromosome and one sex chromosome. Double autosomal aneuploidy is rare and usually results in spontaneous abortions. There are only six published case reports of liveborn with trisomy 18 and trisomy 21 and all of which involve mosaicism. Case Presentation: This case report documents an infant born at 35 weeks with phenotypic features of Down Syndrome. However, cytogenetic analysis showed a mosaic of both trisomy 18 and 21. The patient initially had patent ductus arteriosus requiring operative closure and has congenital hypothyroidism. Conclusion: We describe five possible pathways leading to this phenomenon, including error during meiosis, meiotic nondisjunction, mitotic nondisjunction, sequential mitotic segregation and chimerism. This case report reiterates the significance of traditional cytogenetic analysis in children with features of Down Syndrome to detect any further abnormalities.

Intrapleural streptokinase therapy (IST) is commonly used to manage pediatric parapneumonic effusion. Although considered safe, rare complications, such as pulmonary hemorrhage, have been reported, particularly in high-dose IST administration in patients with coexisting coagulopathy or trauma. We report a case of massive pulmonary hemorrhage following IST in a 14-month-old child with left parapneumonic effusion. He initially presented to the hospital with community-acquired pneumonia, and intravenous antibiotic therapy was initiated. Subsequently, he developed left complex parapneumonic effusion, with worsening respiratory distress requiring non-invasive ventilation. Chest tubes were inserted using the blind method and were complicated by traumatic insertion. Four hours after IST, the patient developed severe respiratory distress with profuse bleeding from the oronasal cavity. He required intubation and was ventilated for four days. There was no coagulopathy. Respiratory support was gradually weaned off, and the patient was discharged well after a six-week course of antibiotics. Healthcare providers should be vigilant regarding the risk of pulmonary hemorrhage, particularly in high-risk patients. Ultrasound-guided chest tube insertion, patient assessment before IST, and close monitoring during and after therapy may help minimize this adverse event. Further research is warranted to better understand the safety profile of IST in children.

Background: Meigs syndrome, pseudo-Meigs syndrome, and pseudo-pseudo-Meigs syndrome showcase a diagnostic challenge in the management of complex pediatric cases. Case report: We report a case of a 6-year-old girl who presented with progressive breathlessness, lethargy, and constipation for two weeks, associated with multiple episodes of joint pain and polymorphous rash. Imaging of the thorax, abdomen, and pelvis suggested bilateral pleural effusion, ascites, and an ovarian mass with abdominal involvement. The pleural and peritoneal fluids were exudative in nature. Unfortunately, she was not fit for a biopsy of the mass and was treated in the intensive care unit for one month. She was initiated on oral corticosteroids for suspicion of an underlying autoinflammatory disease. However, subsequent investigations yielded inconclusive results. She gradually recovered and was well for a year. She presented again with constitutional symptoms and was diagnosed with diffuse large B-cell lymphoma (DLBCL). Thus, it was retrospectively apparent that this was a case of pseudo-Meigs syndrome. Conclusion: We describe an unusual presentation of DLBCL with a temporary resolution of symptoms.

Background: Meigs syndrome, pseudo-Meigs syndrome, and pseudo-pseudo-Meigs syndrome showcase a diagnostic challenge in the management of complex pediatric cases. Case report: We report a case of a 6-year-old girl who presented with progressive breathlessness, lethargy, and constipation for two weeks, associated with multiple episodes of joint pain and polymorphous rash. Imaging of the thorax, abdomen, and pelvis suggested bilateral pleural effusion, ascites, and an ovarian mass with abdominal involvement. The pleural and peritoneal fluids were exudative in nature. Unfortunately, she was not fit for a biopsy of the mass and was treated in the intensive care unit for one month. She was initiated on oral corticosteroids for suspicion of an underlying autoinflammatory disease. However, subsequent investigations yielded inconclusive results. She gradually recovered and was well for a year. She presented again with constitutional symptoms and was diagnosed with diffuse large B-cell lymphoma (DLBCL). Thus, it was retrospectively apparent that this was a case of pseudo-Meigs syndrome.

The clinical presentation symptoms among psychiatric pediatric patients often illustrate the characteristic psychotic features of traumatized children. Cases may go underdiagnosed, misdirected, or commonly treated inappropriately. Clinical studies have conclusively shown an obvious link between childhood trauma and the emergence of symptoms. Transient dissociative episodes are common and normative phenomena during childhood. We reported a case of an 8-year-old boy, who presented with a 5-day history of hallucinatory behavior. He was causing significant nuisances, sudden onset of shouting aggressively, and behavioral changes, associated with neuropsychiatric presentation such as repetitive irregular movement involving his head, neck, and upper limb. There was an asynchrony of symptoms exhibited which were unexplained by clinical semiology or patterns. He was screaming in fear, talking irrelevantly, and acting suspiciously. This was his first presentation to the hospital and no features to suggest organicity. There was no family history of mental illness. No substances, or alcohol and drug usage Serial investigation turned out to be normal and unremarkable. The episodes get frequent whenever parents or hospital staff give more attention toward him. He was given a low dose of antipsychotics, but no obvious rapid changes were observed afterward. Further exploration noted, his parents reported that the patient had been very worked up with past related trauma at school and constantly talking about it. He was afraid, distressed, and anxious as he felt something bad would happen to him. There were significant issues related to attachment figures in this boy, possibly the absent parenting style. He spent most of time playing online games and was preoccupied with them on a daily basis.