Bartonellosi e D-dimero

The paper reports the case of a 17-year-old immunocompetent boy with persistent fever and elevated D-dimer. The family referred contact with kitten and ingestion of homemade deer salami. Abdominal ultrasound scan and CT showed multiple hepatic and splenic abscesses. High levels of antibody title for Bartonella henselae confirmed the diagnosis of hepatosplenic bartonellosis.

L’omocistinuria classica in età pediatrica

Classical homocystinuria is an inborn error of methionin metabolism. It is characterized by an accumulation of homocysteine, due to a deficiency of the enzyme involved in its metabolism, namely cystathionine beta synthase. If not treated, the increase in homocysteine leads to a multisystem syndrome that involves connective tissue, nervous and vascular systems with a predisposition to thromboembolism and developmental delay in childhood. An early diagnosis allows the specific therapy to be promptly started and prevents the classical manifestations of the disease. Since 2016 in Italy homocystinuria detection has been included in the expanded newborn screening. However, it is important not to forget this disease, because of its severe consequences of an untreated condition on the quality and expectancy of life.

Un eritema nodoso dalle molte cause

The authors described the case of a 16-year-old girl presenting with erythema nodosum in the lower limbs eventually attributable to the birth control pill (ethinylestradiol).

Trattamento corticosteroideo versus terapia convenzionale nella corea reumatica

The present retrospective observational study on thirty children with Sydenham chorea shows that steroid treatment seems to be more effective than symptomatic treatment in both clinical remission and clinical improvement of symptoms.

Eritema nodoso: gatta ci cova

Erythema nodosum is a panniculitis that can be triggered by many different stimuli. The paper describes the case of a child who presented with erythema nodosum as the unique clinical manifestation of cat scratch disease. Bartonella henselae infection usually presents with non-tender papule in the scratch line followed by subsequent onset of regional lymphadenopathy eventually associated with systemic symptoms. It can also present with atypical manifestation, such as erythema nodosum. The heterogeneity of the clinical presentations makes the disease to be underdiagnosed, whereby it is important to recognize atypical manifestations. Therefore, it is recommended to include Bartonella henselae serology in the diagnostic evaluation of erythema nodosum.

Affinché non MIS-Cappi il caso: la sindrome infiammatoria multisistemica SARS-CoV-2-correlata

Background - Covid-19 is less frequent and milder in children than in adults. However, cases of multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (MIS-C) have been reported in children, whose phenotype resembles atypical Kawasaki disease. Objectives - The paper describes incidence as well as clinical, laboratoristic and radiological findings of MIS-C. Materials and methods - In the Paediatric Infectious Disease Centre of Palermo (Italy), a targeted surveillance for MIS-C from March 2020 to January 2021 was conducted. Case definition included WHO, UK and US criteria. Results - The paper reports the cases of 9 patients with MIS-C out of which 8 (88%) were hospitalized after September 2020. 44% were male and their median age was 6.5 years. Organ-system involvement included gastrointestinal (66%), cardiovascular (66%), mucocutaneous (88%), reticuloendothelial (77%) and respiratory (55%) systems. C-reactive protein (CRP), procalcitonin, D-dimer and pro-B-type natriuretic peptide levels (pro-BNP) were high in all patients. Chest radiography showed bilateral ground glass-opacities (55%) and pleural effusions (44%). Abdominal imaging findings included small-volume ascites (55%) and mesenteric lymphadenopathy (22%). Echocardiogram showed transient valves regurgitation (55%). In all the patients, the left ventricular ejection fraction was normal and coronary-artery aneurysms were not documented. They were treated with immunomodulating therapies. All patients neither received intensive care nor died. Conclusions - MIS-C represents a new systemic inflammatory syndrome with a phenotype resembling Kawasaki disease. MIS-C remains a rare condition, in which gastrointestinal and mucocutaneous involvement is predominant, nevertheless cardiovascular involvement must be investigated. MIS-C could be suspected even if SARS-CoV-2 exposure precedes the onset of the symptoms by more than 6 weeks. In most cases, a good prognosis might be expected.

“Klingon baby”: quando il sole fa male alla testa

The paper describes the case of a 4-year-old boy who presented with sudden head swelling. Clinical findings sustained the diagnosis of “sunburn of the scalp with subsequent oedema of the cutis adjoining the galeal aponeurosis”. Pathogenesis, differential diagnosis and disease management are also discussed.

Niente di speciale, è solo neuroinfluenza!

Seasonal Influenza may occasionally cause severe neurological complications. The paper describes the case of a 5-year-old child with febrile status epilepticus and Influenza B.

Disturbo della condotta alimentare, ecchimosi e carenza di vitamina C

The paper presents the case of a 16-year-old girl with a 6-month history of eating disorder, restrictive subtype and diffuse ecchymosis. Anamnestic history and laboratory investigations allowed excluding coagulation disorders and making the diagnosis of vitamin C deficiency. Vitamin C deficiency is a rare disease but still sporadically described in children with unusual eating habits.

Perforazione ileale da febbre tifoide

Typhoid fever continues to be a major public health problem in developing countries and mortality is mainly related to its most frequent complication, namely: intestinal perforation. The paper presents the case of a 12-year-old girl with abdominal pain associated with watery diarrhoea, vomiting, fever and general malaise for two weeks. Typhoid fever was suspected, therefore therapy with ceftriaxone was started. Clinical conditions were worsening, so X-ray of the abdomen was performed with evidence of hydro-aerial levels and ultrasound showing abundant non-homogeneous echogenic material in the pelvic cavity, consistent with purulent ascites. Exploratory laparotomy was performed showing an isolated perforation of the ileus, which was sutured. In the postoperative period, antibiotic therapy was boosted with metronidazole and gentamicin. Due to the wound dehiscence, surgical revision with secondary tension sutures was necessary.