The Role of Mediterranean Spotted Fever in the Spectrum of Pediatric Fever with Rashes

When febrile illnesses develop a rash in children, parents are very concerned about a serious disease. Many rashes associated with fever are caused by infectious diseases. Rashes are generally nonspecific and play a supportive role in differential diagnosis, but for some diseases, the appearance of the rash is essential in making a diagnosis. Here is presented the case of a 4-year-old boy with high fever, headache, abdominal pain, vomiting, diarrhea, and a generalized maculo-papular rash including palms and soles. On physical examination were found a black eschar, cervical lymphadenopathy, and hepatosplenomegaly. Laboratory findings resulted in moderate leukocytosis and moderate involvement of the liver and renal function. Based on this finding, a diagnosis of Mediterranean Spotted Fever was performed. The child recovered after medication with azithromycin. Because there is no reliable test that can confirm MSF in its early stages, the diagnosis is commonly made on the basis of clinical findings, so a high index of suspicion should be maintained while evaluating a child with fever and rash.

Multi-System Inflammatory Syndrome in Children (MIS-C), Kawasaki Disease and Toxic Shock Syndrome so Different and Similar

Children are infected with Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), but they are asymptomatic or suffer a mild disease compared to adults. However, the post-infectious immune dysregulation may result in the Multisystem Inflammatory Syndrome in Children (MIS-C). The most common presentations of MIS are fever, gastrointestinal (diarrhea, vomiting, abdominal pain), cardiovascular, mucocutaneous (rash, mucus membrane changes, conjunctival injection), respiratory (including sore throat), headache, limb and periorbital edema, and elevated inflammation markers. Some clinical and laboratory features of MIS-C are similar to other systemic diseases of childhood as Kawasaki disease and Toxic Shock Syndrome. Here are reported three cases in children with MIS-C, Kawasaki disease and Toxic Shock Syndrome to highlight the similarities and differences of these diseases.

A Severe Form of COVID-19 in an Infant with Underlining Undiagnosed Acute Myeloid Leukemia

The new global pandemic of coronavirus disease 2019 (COVID-19) is caused by the novel coronavirus designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in December 2019, in an outbreak of respiratory illness of unknown in China. The virus spread rapidly all over the world, and on March 11, 2020 the World Health Organization (WHO) declared COVID-19 a global pandemic. Although childhood COVID-19 cases appeared early in the outbreak, the disease burden in children is far less than in adults. The clinical presentation in adults ranges from mild illness to severe pneumonia, acute respiratory distress syndrome, acute cardiac failure, and thromboembolic complications. Children experience critical illness far less than adults with lesser degree of admission to the intensive care unit and mortality. Here is reported the case of an 8-month infant who was admitted for a severe form of COVID-19 and contemporaneously was discovered an underlining, unknown before, myelodysplastic disorder. Concerning a child with severe form of COVID-19, a high index of suspicion should be maintained towards underling diseases which compromise the immune system such as the case of acute myeloid leukemia.

COVID-19 and EBV Co-Infection in a Child

Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), reported first in December 2019 in Wuhan, China. The virus soon spread all over the world and the World Health Organization (WHO) declared a global pandemic on March 11, 2020. At the beginning of the outbreak, infections were more common in adults then in children;however, in the following months, the number of pediatric infection cases increased significantly. The disease in children is less severe, but occasionally it may be complicated with Multisystem Inflammatory Syndrome. Some of the symptoms and signs may be overlapped with other infectious diseases of the childhood and confound the appropriate diagnosis. A high index of suspicion must be maintained in children while making a diagnosis. We report the case of a 5 years old presented with COVOD-19 and EBV co-infection.

Muco-Cutaneous Changes Following COVID-19 in Children

Coronavirus disease 2019 (COVID-19) is an illness caused by the novel coronavirus designated as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It was first identified in Wuhan, China, in December 2019, and soon spread all over the world causing a global pandemic. Since the beginning of the pandemic, fewer cases of COVID-19 have been reported in children than in adults. Most cases have been mild and only a small proportion of infected children needed hospitalization. As the pandemic evolved, it was soon evident that immune dysregulation inflicted by the virus, posed children at risk for their lives. It is still hard to predict its effects on children health and well-being. Here are reported a series of cases of muco-cutaneous changes following COVID-19 infection in children. Children ranged from 8 months to ten years. They had a history of a recent COVID-19 infection (1 - 3 months ago), with a RT-PCR for COVID-19 negative, SARS-CoV-2 IgM negative and a positive SARS-Cov-2 IgG. Their presentation was consistent with a late reaction to COVID-19 reaction with muco-cutaneous changes dominating the scenery.

Amebiasis as the Cause of Pediatric Fever of Unknown Origin

Amebiasis is a parasitic infection caused by the protozoa Entamoeba histolytica. It is capable of causing a spectrum of illnesses from asymptomatic infection, to dysentery and invasive extra-intestinal conditions, the most common of which is liver abscess. Here is presented the case of a 14-month old boy presented with Fever of Unknown Origin, which after work-up was diagnosed as amebic liver abscess. Although amebiasis is more prevalent in developing countries the increasing phenomena of migration and tourism has transformed it into a global health issue. It is recommended to maintain a high index of suspicion while valuating a child with Fever of Unknown Origin.

Erythema Nodosum Following EBV Infection in a Child

Epstein-Barr virus (EBV) is one of the eight known human herpesviruses, which is widespread in nature and infects most of the world population. In infants and young children, primary infection is usually asymptomatic or produces an acute illness that is often not recognized as being due to EBV. It has a well-established oncogenic potential, and has been implicated in the pathogenesis of various autoimmune diseases. Here is reported the case of a 32-months old boy, who presented with a history of two days of low-grade fever, pain in both legs, swollen ankles and inability to walk. On physical examination, the child appeared moderately ill, without fever. On both shins were observed nodules 2 - 3 cm in diameter, red to bluish in color, firm and poorly demarcated. Clinically, a diagnosis of Erythema nodosus was performed. Laboratory examinations revealed increased inflammatory parameters. After a full workup, EBV was established as the causative agent. Erythema nodosum is the most common form of panniculitis in children;however, it is relatively uncommon in the pediatric population. It is a self-limited disease, and most of infectious origin in children. Although uncommon, EBV infection is a potential cause of pediatric erythema nodosum.