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.

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.