SARS-CoV-2 Infection as a Possible Trigger for IgA-Associated Vasculitis: A Case Report.

BACKGROUND: IgA-associated vasculitis (IgAV), formerly known as Henoch-Schönlein purpura (HSP) disease, is the most common type of systemic vasculitis observed during developmental age. Available published studies associate the outbreak of the disease with streptococci, adenovirus, parvovirus, mycoplasma, respiratory syncytial virus (RSV), and influenza infection in approximately 50% of patients with HSP, while some emerging reports have described a few cases of COVID-19 infection being associated with HSP in both adults and children. CASE PRESENTATION: a 7-year-old girl was diagnosed with HSP, fulfilling the four required clinical criteria (palpable purpura and abdominal pain, arthralgia and edema, and periodic renal involvement). Infection with SARS-CoV-2 was confirmed via the presence of IgM and IgG antibodies. The disclosure of the Henoch-Schönlein purpura (HSP) disease was preceded by a mild, symptomatically treated infection of the upper respiratory tract. High levels of inflammatory markers were observed during hospitalization, including leukocytosis, an increased neutrophil count and a high neutrophil-to-lymphocyte ratio (NLR). All of these markers are associated with IgAV gastrointestinal bleeding, which was also associated with rotavirus diarrhea observed in the patient. CONCLUSIONS: This case presented by us and similar cases presented by other authors indicate the possible role of SARS-CoV-2 in the development of HSP, but this assumption requires further research and evidence-based verification.

Pulmonary Function in Paediatric Patients with Inflammatory Bowel Disease.

BACKGROUND: Among the extraintestinal manifestations of inflammatory bowel disease (IBD), those involving the lungs are relatively rare and often overlooked. There are only scarce data on the prevalence of IBD-associated lung involvement in children. OBJECTIVES: The aim of our study was to assess pulmonary function in IBD children by different methods and to evaluate the influence of immunosuppressive therapy on disease severity. METHODS: Seventy-two children with IBD (mean age of 14.45 ± 2.27 years) and 40 age-matched healthy controls (mean age of 14.17 ± 2.82) were included in the study. Pulmonary function tests (PFTs) were carried out by means of spirometry, oscillometry (IOS) and fractional exhaled nitric oxide (FeNO) to assess the pulmonary involvement. RESULTS: Certain differences were observed between the study group and the control group, regarding the spirometric and oscillometry parameters. The fractions of exhaled nitric oxide did not differ between the group with IBD patients and the control group with regards to disease activity, the duration of illness and the administered immunosuppressive treatment. CONCLUSIONS: The mean spirometry results were significantly different in the study group compared to the controls, although they were still within the normal limits. The pulmonary function abnormalities did not depend on either the disease activity or the immunosuppressive therapy. Oscillometry could be a supplementary method to assess pulmonary resistance. In turn, FeNO does not appear to be useful either in screening IBD children for pulmonary involvement or for the evaluation of disease activity. It appears then that only general screening of asymptomatic patients is a suitable method and a necessary recommendation in this population, prompting a revision of the current diagnostic approach.

Diagnostic difficulties in the diagnosis of high acute-phase proteins levels in a teenage drug addicted female patient.

BACKGROUND: Youth drug addiction is a significant social and health problem. Symptoms of the disease include a number of neurological, gastrointestinal and cardiovascular disorders. Possible hormonal disorders and dysregulation of the immune system could also occur. CASE PRESENTATION: We describe a case of a teenage patient with multiple diseases such as esophagitis, allergic disease, and numerous behavioral disorders leading to: self-injury of the body, suicide attempts by drugs overdosing, and experimentation with various psychoactive substances (morphine, amphetamine, methamphetamine, codeine). She was also diagnosed with bipolar disorder. A few hours before the admission to the ward, the patient had an intravenous injection of drugs. Toxicological tests confirmed the presence of amphetamine, ecstasy and opioids in the blood and urine. Laboratory tests revealed extremely increased inflammatory parameters, leucopenia, increased levels of IgG, IgA and IgE (total) immunoglobulins, low concentration of vitamin D. Bacteriological examinations were negative. General condition of the patient got better very quickly, antibiotic therapy was abandoned on the 4th day. It was concluded that the cause of the elevated concentration of acute-phase proteins was most likely caused by intoxication with psychoactive drugs. CONCLUSIONS: The discussed case shows the difficulties of differential diagnosis in a teenage patient struggling with many diseases, who has been abusing drugs for several years. Increased inflammatory parameters in the form of an raised PCT, CRP, NLR, PLR values may be caused by many factors. In adolescents who frequently experiment with psychoactive substances, such cause of these disturbances should also be taken into account.

[Assessment of the natural history and clinical presentation of acetonemic vomiting]. / Ocena przebiegu i obrazu klinicznego wymiotów acetonemicznych u dzieci.

INTRODUCTION: Ketosis in children may result from physiological adaptation to situations like fasting, fat-rich diet, straining physical activity, as well as from serious endocrine or metabolic disorders. The most frequently diagnosed cause of ketoacidosis are states of acetonemia and acetonuria with vomiting, during airways infections. GOAL: Assessment of the natural history and clinical presentation of acetonemic vomiting in children. PATIENTS AND METHODS: 85 children from 18 months to 12 years of age with acetonemic vomiting were incorporated in this study. Detailed anamnesis, clinical examination, and chosen laboratory parameters were analyzed. RESULTS: In 18% of the children a familial pattern of the disease was observed, 75% of the parents declared that their children had fat-rich meals on a regular basis, in 47% there was a tendency to recurrent respiratory tract. The most frequently observed symptoms were incoercible vomiting with nausea (100%), abdominal pain (87%), headaches (35%) and febrile states (62%). Ketosis triggers were: infections with insufficient fluid and food intake (68%), and child overfeeding with fat-rich products (23%). Observed biochemical disturbances were ketosis (mean J3-hydroxybutyric acid serum concentration--1.03 mmol/l, SD +/- 0.83), acetonuria, hypoglycemia (15%), metabolic acidosis (17%) and dyselectrolytemia (14%). The treatment of the children consisted in intravenous and oral rehydration, managing acid-base and electrolyte disturbances. CONCLUSION: In some children acetonemic vomiting is recurrent, and thus prophylactic management is im- portant in children who are at risk.

[Etiology and clinical course of urticaria in hospitalized children]. / Etiologia i przebieg kliniczny pokrzywkiu hospitalizowanych dzieci.

INTRODUCTION: Data concerning the epidemiology, etiology and clinical course of childhood urticaria are still under discussion. AIM: To investigate the clinical presentation of urticaria in hospitalized children and to define its possible etiologies. MATERIAL AND METHODS: Ninety eight children (male/female 42/57) aged 0.2-17.6 years, (mean age 8.22±0.55) hospitalized due to urticaria were included in the study. The nature and localization of skin lesions, accompanying diseases and diagnostic test results were analyzed. RESULTS: Sixty nine children (70.4%) were diagnosed as having acute, 22 (22.5%) acute recurrent and 7 (7.1%) chronic urticaria. Allergic diseases, family history of atopy and adenoid hypertrophy and/or chronic tonsillitis were present respectively in 10 (10.2%), 28 (28.6%), 21 (21.4%) children. In 32 children (46.3%) with acute urticaria, in 8 (36.3%) with recurrent and in 2 (28.5%) with chronic urticaria skin lesions covered the whole body. Serum C-reactive protein and leukocyte levels in children with acute urticaria were significantly higher compared to children with chronic urticaria (p<0.05). The serum IgE levels, the percentage and absolute count of eosinophils were similar in different forms of urticaria. Probable etiology in 62/69 children with acute urticaria (respiratory tract infections - 43, drugs - 8, lambliosis - 6, food allergy - 2, antiallergy shots - 2, urinary tract infection - 1 child), in 9/22 children with recurrent urticaria (respiratory tract infection - 7, lambliosis - 2 children) and in 3/7 children with chronic urticaria (physical urticaria - 2, urinary tract infection - 1 child) was determined. CONCLUSIONS: Among children with urticaria, the most frequent cause for hospitalization is acute urticaria. The outbreak of hives wheels is usually triggered by upper respiratory tract infection. IgE-related allergy is a rare reason of childhood urticaria. In more than 50% of cases of recurrent and chronic urticaria the etiology was not determined.

Serum apelin-12 level is elevated in schoolchildren with atopic asthma.

BACKGROUND: There are limited data on the role of adipokines in atopic asthma. AIM: To determine serum level of apelin-12 (APE-12) in asthmatic children in relation to BMI and gender. METHODS: Serum APE-12 levels were measured using ELISA in 89 asthmatic children (61 boys and 28 girls, aged 7.0-17.0 years) and in 33 healthy children. Among examined asthmatics 59 (19 girls and 40 boys) had normal weight and 30 (9 girls and 21 boys) were obese. RESULTS: The mean serum levels of APE-12 were significantly (p < 0.001) higher both in obese (174.1 ± 5.9 pg/mL) and non-obese asthmatic children (171.0 ± 4.0 pg/mL) than in healthy children (130.6 ± 2.1 pg/mL), regardless of gender. No relationships between examined the adipokine level and asthma severity, spirometric parameters, degree of allergic sensitization, BMI, BMI-SDS were observed. CONCLUSION: Increased serum level of APE-12 suggests that this adipokine may be implicated in the pathogenesis of childhood atopic asthma.

[RSV infection course in infants and young children during hospitalization]. / Przebieg zakazen RSV u hospitalizowanych niemowlat i malych dzieci.

Respiratory syncytial virus (RSV) infection is a widespread among the youngest group of pediatric patients, especially in the young infant, when the immune system is just being formed. A lot of children up to 5 year-old suffer infection many times, not only because of easy pathogen transfer, but also primary incidence of disease doesn't give permanent immunity. This study retrospectively analyses a group of children with confirmed during epidemic period RSV infection. Particular attention was paid to the infection risk factors, varied clinical manifestations of infection, abnormal additional studies and accessible prophylactic action. The treatment and correlation between RSV, recurrent wheezing and asthma were discussed.