Distinguishing orbital cellulitis from preseptal cellulitis in children.

PURPOSE: We aimed to evaluate clinical and laboratory characteristics of children with preseptal cellulitis (PC) and orbital cellulitis (OC) and also to determine whether clinical and/or laboratory parameters could be used to distinguish OC from PC. METHODS: The medical records of pediatric patients (aged between 1 month and 18 years) with PC and OC who had been hospitalized at our center from January 2008 to December 2020 were retrospectively reviewed. Multivariable regression analysis was performed to identify possible parameters useful in differentiating between PC and OC. RESULTS: A total of 375 patients [202 (53.9%) boys], of whom 35 (9.3%) had OC, were evaluated. Median age was 44 (range, 1-192) months. Compared to those with PC, patients with OC were older (p = 0.001), had fever, upper respiratory tract infection (URTI) symptoms, and sinusitis more frequently, and demonstrated prolonged symptom and hospitalization times (p Ë‚ 0.001 for all). Significant differences between groups were observed for numerous laboratory parameters; however, multivariable regression analysis revealed that only C-reactive protein (CRP) and platelet count could be used to predict OC among the laboratory findings. Taken together, factors independently associated with OC diagnosis were proptosis, ophthalmoplegia, age (>35 months), CRP level (˃116.5 mg/L), and platelet count (˃420.5 × 103/mm3). CONCLUSION: In addition to showing previously known properties of OC versus PC, our study demonstrated that combined demographic, clinical and laboratory factors such as being aged above 35 months, having a CRP level of ˃116.5 mg/L, and platelet count of ˃ 420.5 × 103/mm3 could be used to distinguish OC from PC.

Multisystem inflammatory syndrome in children during severe acute respiratory syndrome coronavirus-2 pandemic in Turkey: A single-centre experience.

AIM: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) infection may result in a life-threatening hyperinflammatory condition named multisystem inflammatory syndrome in children (MIS-C). We aimed to assess demographics, clinical presentations, laboratory characteristics and treatment outcomes of patients with MIS-C. METHODS: We performed a retrospective study of patients with MIS-C managed between August 2020 and March 2021 at Dr. Sami Ulus Maternity Child Health and Diseases Training and Research Hospital in Turkey. RESULTS: A total of 45 patients (23 male, 51%) with a median age of 8.7 years (interquartile range: 5.6-11.7 years) were enrolled to study. The SARS-CoV-2 serology was positive in 43 (95%) patients. Organ-system involvement included the dermatologic in 41 (91%), cardiovascular in 39 (87%), hematologic in 36 (80%) and gastrointestinal in 36 (80%) patients. Acute anterior uveitis was diagnosed in nine (20%) patients. Two patients presented with clinical findings of deep neck infection such as fever, neck pain, trismus, swelling and induration on the cervical lymph node. One patient presented with Henoch-Schonlein purpura-like eruption. Coronary artery dilatation was detected in five (11%) patients. For treatment of MIS-C, intravenous immunoglobulin was used in 44 (98%) patients, methylprednisolone in 27 (60%) and anakinra in 9 (20%) patients. The median duration of hospitalisation was nine days. All patients recovered. CONCLUSIONS: Children with MIS-C might have variable clinical presentations. Acute anterior uveitis might be a prominent presentation of MIS-C and require ophthalmological examination. It is essential to make patient-based decisions and apply a stepwise approach for the treatment of this life-threatening disease.