Calcineurin inhibitors remain a cornerstone in the treatment of steroid-resistant nephrotic syndrome (SRNS) in pediatric patients. Hypomagnesemia, a clinically relevant yet frequently neglected complication of calcineurin inhibitors like cyclosporine, may exacerbate hypokalemia and induce neuromuscular symptoms such as tetany, challenging patient management. However, serum magnesium is not routinely monitored in many clinical settings. A 46-month-old girl with SRNS had been receiving high-dose cyclosporine for over 1 year. She was admitted with vomiting, diarrhea, generalized edema, and hypovolemic shock. After stabilization, she developed persistent hypokalemia refractory to supplementation, despite normal renal function and basic electrolyte panel. On hospital day 10, carpal-type tetany prompted the first measurement of serum magnesium, revealing severe hypomagnesemia (0.14 mmol/L). Cyclosporine was temporarily withheld, and intravenous then oral magnesium was administered. Tetany resolved within 48 hours, and both serum magnesium and potassium levels normalized. This case highlights the risk of delayed recognition of symptomatic hypomagnesemia during prolonged cyclosporine therapy in children. Tetany was the first neurological manifestation of a preventable complication. Current guidelines lack clear recommendations regarding magnesium surveillance in pediatric SRNS receiving cyclosporin. This case underscores a critical gap in practice and calls for the integration of magnesium monitoring into standard care for this vulnerable population.

A clear understanding of the risk factors and key predictors of typhoid fever in endemic, low-resource settings is essential for informing effective prevention strategies and guiding empiric patient management. This study aimed to identify the predictors and risk factors linked to culture-confirmed typhoid fever in Mukuru informal settlements in Nairobi, Kenya. Between November 2020 and July 2025, patients presenting with a fever of ≥ 38 °C, and/or with diarrhea were enrolled at seven health facilities in the Mukuru settlements. Structured questionnaires and case report forms were used to collect socio-demographic, environmental, and clinical data. Blood and stool cultures were performed to confirm the presence of Salmonella Typhi (S. Typhi). The associations between potential risk factors and typhoid positivity were analysed using chi-square tests and multivariable logistic regression to estimate adjusted odds ratios (aOR) with 95% confidence intervals (CI). Of the 8,950 patients enrolled, 131 (1.46%, 95% CI:1.23-1.73%) had S. Typhi positive blood culture. In the adjusted analysis, patients aged 5-16 years (aOR 2.50, 95% CI 1.55-4.04) and those over 16 years (aOR 2.16, 95% CI 1.41-3.31) had significantly higher odds of typhoid infection compared to children under five. Continuous fever (fever ≥ 38 °C for the last 3 days) (aOR 3.48, 95% CI 2.11-5.73), vomiting (aOR 1.89, 95% CI 1.29-2.75), moderate dehydration (aOR 2.95, 95% CI 1.25-6.95), and headache (aOR 1.68, 95% CI 1.12-2.53) were independently associated with typhoid infection. Households with two or more children under five years had increased odds of infection (aOR 1.98, 95% CI 1.28-3.07). Usage of a shared flush toilet was significantly associated with increased odds of typhoid infection (aOR = 2.42, 95% CI: 1.69-3.47, p < 0.001). Our findings demonstrate that typhoid fever in Mukuru informal settlements is driven by factors such as age, unsafe water practices, and shared sanitation. Interventions, such as strengthening water, sanitation, and hygiene (WaSH) infrastructure and practices are vital to reducing typhoid fever risk in these endemic settings.

Gastrointestinal perforation is a rare but potentially life-threatening complication of ventriculoperitoneal (VP) shunts. Patients may have minimal or no abdominal symptoms despite bowel perforation and the risk of ascending central nervous system infection.