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Episodic central neurogenic hyperventilation in an awake child with systemic histiocytosis
G J Hool1, H M Marsh, R V Groover
1Department of Anesthesiology, Mayo Clinic, Rochester, Minnesota.
Insights
Systemic histiocytosis can cause central neurogenic hyperventilation, a rare breathing disorder. This complication, observed after radiation therapy, resolved spontaneously in a young patient.
Area of Science:
- Pediatric Oncology
- Neurology
- Endocrinology
Background:
- Systemic histiocytosis is a rare disorder involving abnormal proliferation of histiocytes.
- Diabetes insipidus and bone lesions are known manifestations.
- Central neurogenic hyperventilation is a rare respiratory abnormality.
Observation:
- A 3-year-old boy with systemic histiocytosis, diabetes insipidus, and a parietal bone lesion presented with central neurogenic hyperventilation.
- Symptoms appeared 3 weeks post-radiation therapy to the head.
- The patient was conscious and alert, with significant respiratory alkalosis (PaCO2 8 mmHg, pH 7.65).
Findings:
- Magnetic resonance imaging revealed a pontomedullary lesion.
- The lesion resolved within a year.
- Central neurogenic hyperventilation was not previously described as a complication of systemic histiocytosis.
Implications:
- This case highlights a novel potential complication of systemic histiocytosis and its treatment.
- It underscores the importance of considering neurogenic causes for respiratory abnormalities in affected children.
- The spontaneous resolution suggests potential for recovery with appropriate monitoring.
Abstract:
A 3 year old boy with systemic histiocytosis, diabetes insipidus and a lytic parietal bone lesion experienced episodes of central neurogenic hyperventilation 3 weeks after radiation to the head but was conscious and alert at presentation. At admission, the PaO2 was 133 mmHg, PaCO2 was 8 mmHg and pH 7.65. Magnetic resonance imaging revealed a pontomedullary lesion that resolved during the ensuring year. Central neurogenic hyperventilation has not been described previously as a complication of systemic histiocytosis.