Cryptococcosis with pulmonary cavitation in an immunocompetent child: a case report and literature review.

BACKGROUND: Pulmonary cryptococcosis (PC) rarely occurs in immunocompetent children. CASE PRESENTATION: A 13-year-old boy was admitted to the First Affiliated Hospital of Ningbo University in February 2023 with complaints of cough and chest pain. Physical examination showed slightly moist rales in the right lung. Chest computed tomography (CT) suggested a lung lesion and cavitation. Blood routine test, lymphocyte subsets, immunoglobulin, and complement tests indicated that the immune system was normal. However, the serum cryptococcal antigen test was positive. Next-generation sequencing revealed Cryptococcus infection. The child was diagnosed with PC and was discharged after treating with fluconazole 400 mg. Four months later, chest CT showed that the lung lesion diminished, and reexamination of serum cryptococcal antigen test turned positive. CONCLUSION: PC should be considered in an immunocompetent child with pulmonary cavities with nonspecific symptoms.

Effects of subcutaneous immunotherapy in allergic rhinitis children sensitive to dust mites.

BACKGROUND: Subcutaneous immunotherapy (SCIT) is now the only treatment that can modify the natural course of allergic rhinitis (AR). However, not all children with AR benefit from SCIT. OBJECTIVE: To evaluate the efficacy of SCIT in dust-mites-induced AR children and explore correlative factors predicting treatment response to SCIT. METHODS: 225 children aged 4-17 years old with AR were recruited from January 2016 to September 2019, and monitored at baseline, 4, 12, and 24 months after the start of SCIT treatment. The visual-analogue-score (VAS) was used to assess the clinical symptoms. Multivariate binary logistic regression analyses and receiver operating characteristic curves were used to explore correlative factors in predicting the efficacy of SCIT. RESULTS: The significant declines in VAS started after 4 months of SCIT and continued to improve throughout the study compared with baseline. An increase in children's age (OR=0.688, 95%CI: 0.479-0.988) and those with allergic history (OR=0.097, 95%CI: 0.009-1.095) were negatively associated with the risk of poor efficacy. Polysensitized children were more likely to suffer poor efficacy (OR=15.511 95%CI: 1.319-182.355). The clinical response at month 4 (r=0.707) and month 12 (r=0.925) was related to that at month 24. The area under the curve (AUC) for improvement at month 4 and month 12 was 0.746 and 0.860, respectively. CONCLUSION: Our study confirmed the clinical efficacy of SCIT in AR children. Children with younger age, negative allergic history, and multiple allergens may predict a worse efficacy. The onset of action and the clinical response to SCIT in the second year can be predicted as early as by month 4.

Four Discrete Silver Iodobismuthates/Bromobismuthates with Metal Complexes: Syntheses, Structures, Photocurrent Responses, and Theoretical Studies.

Using in situ formed metal complexes of [Fe(bipy)3]2+ or [Ni(bipy)3]2+ (bipy = 2,2'-bipyridine) as templates, four new Ag-Bi-X (X = I and Br) compounds are first isolated in the metal-complex-decorated heterometallic halobismuthate family, namely [M(bipy)3]AgBiI6 (M = Fe (1), Ni (2)), [Fe(bipy)3]AgBiBr6 (3), and [Ni(bipy)3]AgBiBr6 (4). Compounds 1-4 feature discrete [AgBiX6]n2n- anions, exhibiting three polymorphisms that may be ascribed to the different stackings and the flexible condensations of [BiX6] octahedrons and [AgX4] tetrahedra/[AgX3] triangles. UV-vis diffuse reflectance analyses reveal that they are narrow band gap semiconductor materials (ca. 1.82-2.13 eV). Intriguingly, the title compounds display excellent photoelectrical switching properties, with photocurrent density following the order 3 > 4 > 2 > 1. In addition, the comparative studies of intermolecular interactions, theoretical band structures, density of states, and effective masses of three polymorphisms have also been investigated.

Inhaled B7 alleviates bleomycin-induced pulmonary fibrosis in mice.

Treatment options for the progression of pulmonary fibrosis (PF), which ultimately causes respiratory failure, are limited. According to recent studies, recombinant human relaxin is potentially therapeutic against fibrosis and contraction during pulmonary damage. However, the production of recombinant H2 relaxin is laborious and expensive, limiting its extensive application. Thankfully, alternative research has revealed that treatment with a single-chain peptide of relaxin attenuates organ fibrosis in rodent models too, with the production of a single-chain peptide of relaxin simple and cheap; it could be therapeutic against idiopathic pulmonary fibrosis. Here, we explored the probable inhibiting effects of B7, a B chain of recombinant human relaxin, on bleomycin-induced pulmonary inflammation. Inhaled B7 efficiently reduced the number of inflammatory leukocytes and neutrophils in the bronchoalveolar lavage fluid of mice with bleomycin-induced PF, significantly improved the structure of the damaged alveolar, reduced collagen deposition, suppressed the main pathological features of idiopathic pulmonary fibrosis, i.e. the expression of both pulmonary α-smooth muscle actin and pulmonary vimentin, and inhibited the transcription of inflammation and collagen deposition-related mRNAs, including fibronectin, α-smooth muscle actin (α-SMA), interleukin-1ß (IL-1ß), interleukin-6 (IL-6), and alpha-1 type 1 collagen (Col-1a), and the expression of inflammation-related proteins, such as IL-1ß, IL-6, chemokines (KC), TIMP metallopeptidase inhibitor 1 (TIMP-1), and hydroxyproline (Hyp). Overall, our findings suggest that inhaled B7 exerts beneficial effects against pulmonary fibrosis via attenuating inflammation. It could be developed into a simple, highly effective therapeutic approach for pulmonary fibrosis.

Identification of pediatric respiratory diseases using a fine-grained diagnosis system.

Respiratory diseases, including asthma, bronchitis, pneumonia, and upper respiratory tract infection (RTI), are among the most common diseases in clinics. The similarities among the symptoms of these diseases precludes prompt diagnosis upon the patients' arrival. In pediatrics, the patients' limited ability in expressing their situation makes precise diagnosis even harder. This becomes worse in primary hospitals, where the lack of medical imaging devices and the doctors' limited experience further increase the difficulty of distinguishing among similar diseases. In this paper, a pediatric fine-grained diagnosis-assistant system is proposed to provide prompt and precise diagnosis using solely clinical notes upon admission, which would assist clinicians without changing the diagnostic process. The proposed system consists of two stages: a test result structuralization stage and a disease identification stage. The first stage structuralizes test results by extracting relevant numerical values from clinical notes, and the disease identification stage provides a diagnosis based on text-form clinical notes and the structured data obtained from the first stage. A novel deep learning algorithm was developed for the disease identification stage, where techniques including adaptive feature infusion and multi-modal attentive fusion were introduced to fuse structured and text data together. Clinical notes from over 12000 patients with respiratory diseases were used to train a deep learning model, and clinical notes from a non-overlapping set of about 1800 patients were used to evaluate the performance of the trained model. The average precisions (AP) for pneumonia, RTI, bronchitis and asthma are 0.878, 0.857, 0.714, and 0.825, respectively, achieving a mean AP (mAP) of 0.819. These results demonstrate that our proposed fine-grained diagnosis-assistant system provides precise identification of the diseases.

[Diagnosis and treatment recommendation for pediatric COVID-19 (the second edition)].

The coronavirus disease 2019 (COVID-19) has caused a global pandemic. All people including children are generally susceptible to COVID-19, but the condition is relatively mild for children. The diagnosis of COVID-19 is largely based on the epidemiological evidence and clinical manifestations, and confirmed by positive detection of virus nucleic acid in respiratory samples. The main symptoms of COVID-19 in children are fever and cough; the total number of white blood cell count is usually normal or decreased; the chest imaging is characterized by interstitial pneumonia, which is similar to other respiratory virus infections and Mycoplasma pneumoniae infections. Early identification, early isolation, early diagnosis and early treatment are important for clinical management. The treatment of mild or moderate type of child COVID-19 is mainly symptomatic. For severe and critical ill cases, the oxygen therapy, antiviral drugs, antibacterial drugs, glucocorticoids, mechanical ventilation or even extracorporeal membrane oxygenation (ECMO) may be adopted, and the treatment plan should be adjusted timely through multi-disciplinary cooperation.

Study of Two Separate Types of Macrolide-Resistant Mycoplasma pneumoniae Outbreaks.

To study the complete natural process of a Mycoplasma pneumoniae outbreak in a semiclosed room such as a primary school room, we investigated two separate M. pneumoniae outbreaks involving 81 students in total in two primary schools in Hangzhou, China. M. pneumoniae isolates from pharyngeal swabs were detected by fluorescence quantitative real-time PCR (RT-PCR) and culture. The class in school M had 39 students, with 12 (30.8%) with positive M. pneumoniae detection results. The class from school J had 42 students, with 13 (31.0%) positive. The strains from two classes were confirmed to represent two clones (3/4/5/7/2 and 5/4/5/7/2) and to be macrolide resistant (A2063G) according to P1 and multilocus variable-number tandem-repeat analysis (MLVA) genotyping, determination of MIC of antibiotics, and sequencing. Students with M. pneumoniae isolates detected were divided into three groups: those carrying the isolates, those with upper respiratory tract infection (URI), and those with pneumonia. Longitudinal sampling performed using pharyngeal swabs showed that the persistence of M. pneumoniae was longest in the group of students with pneumonia. M. pneumoniae causes pneumonia outbreaks in schools, and the incidence of pneumonia has a higher rate than that of URI. The persistence of M. pneumoniae, with a median duration of 79.50 days in the group of students with pneumonia, differs from that of the infection state.

Prevalence and risk factors for asthma among children aged 0-14 years in Hangzhou: a cross-sectional survey.

BACKGROUND: Asthma is a global problem. Prevalence varies among different countries and cities. We aimed to obtain the prevalence, describe the characteristics, and discover factors that may relate to asthma in Hangzhou. METHODS: This cross-sectional study was conducted in Hangzhou. The subjects were children aged 14 years and younger. A control group of non-asthma children that matched in age and sex with each asthmatic patient was also randomly selected and interviewed. International Study of Asthma and Allergies in Childhood and National Epidemiology study of Asthma and Allergies in China questionnaires were used in this survey. RESULTS: We have questionnaired 13,877 children, and 665 (4.8 %) children were diagnosed asthma. The guardians regarded the cost of asthma management affordable in 49.4 %, tolerable in 46.9 %, and intolerable in 3.7 %. Both guardians and children have been absent from work or school due to children's asthma. Respiratory tract infection was the most common trigger of asthma attacks (85.1 %). Other common causes included cold air, house dust, exercise, fish and shrimp, pollen, and et al. Interestingly, we also found in children 6 years and older, some triggers happened more than that in children 5 years and younger. Those factors included exercise, emotional changes, house dust, pollen, renovation works in the home, mosquito-repellent incense and pets (all the p values were <0.05). We compared some factors may relate to asthma development. Higher percentage of family history of asthma, personal history of allergy (atopic dermatitis, drug allergy and food allergy), comorbidities (allergic rhinitis, sinusitis, adenoidal hypertrophy, and urticaria), caesarean birth and complications ever happened during pregnancy were discovered in asthma children than in non-asthma children (all the p values were <0.05). Exclusive breastfeeding within first 6 months and keeping animals had higher percentage in non-asthma children than in asthma (both the p values were <0.05). Inhaled corticosteroid (ICS)/ICS + long-acting beta2 agonists (LABA) was applied to 46.2 % of patients. Traditional Chinese medicine (TCM) was used in 44.2 % of asthma children, while leukotriene receptor antagonist (LTRA) was used in 36.4 % of them. The adherence scored higher in TCM than in ICS/ICS + LABA (P = 0.003) and LTRA. CONCLUSIONS: In conclusion, we conducted an epidemiology study in Hangzhou. The prevalence of childhood asthma was 4.8 %. Asthma was an economic and social burden to both children and guardians. Risk factors of asthma development may include caesarean birth, personal history of allergy and concomitant allergic diseases. Exclusive breastfeeding within first 6 months and keeping animals might be protecting factors. TCM was really popular in China besides ICS/ICS + LABA and LTRA.

Treatment of infantile subglottic hemangioma with oral propranolol.

Infantile subglottic hemangioma (SH) can cause biphasic stridor, respiratory distress and even life-threatening airway compromise. Treatment of SH in infants has traditionally been characterized as a challenging situation with multiple therapeutic options without consensus as to which one is the best and with risks of severe side-effects. Four infants with SH were treated with propranolol. Treatment with oral propranolol resulted in resolution of symptoms within 2 days, followed by complete recovery. Propranolol appears to be an effective treatment for SH and should be used as a first-line treatment for SH when intervention is required.

Global secretome characterization of A549 human alveolar epithelial carcinoma cells during Mycoplasma pneumoniae infection.

BACKGROUND: Mycoplasma pneumoniae (M. pneumoniae) is one of the major etiological agents for community-acquired pneumonia (CAP) in all age groups. The early host response to M. pneumoniae infection relies on the concerted release of proteins with various biological activities. However, no comprehensive analysis of the secretory proteins has been conducted to date regarding the host response upon M. pneumoniae infection. RESULTS: We employed the liquid chromatography-tandem mass spectrometry (LC-MS/MS)-based label-free quantitative proteomic technology to identify and characterize the members of the human alveolar epithelial carcinoma A549 cell secretome during M. pneumoniae infection. A total of 256 proteins were identified, with 113 being differentially expressed (>1.5-fold change), among which 9 were only expressed in control cells, 10 only in M. pneumoniae-treated cells, while 55 were up-regulated and 39 down-regulated by M. pneumoniae. The changed expression of some of the identified proteins was validated by RT-PCR and immunoblot analysis. Cellular localization analysis of the secretome data revealed 59.38% of the proteins were considered as "putative secretory proteins". Functional analysis revealed that the proteins affected upon M. pneumoniae infection were mainly related to metabolic process, stress response, and immune response. We further examined the level of one up-regulated protein, IL-33, in clinical samples. The result showed that IL-33 levels were significantly higher in the plasma and bronchoalveolar lavage fluid (BALF) of M. pneumoniae pneumonia (MPP) patients. CONCLUSIONS: The present study provided systematic information about the changes in the expression of secretory proteins during M. pneumoniae infection, which is useful for the discovery of specific biomarkers and targets for pharmacological intervention.

Molecular Epidemiology of Human Parainfluenza Virus Type 3 in Children With Acute Respiratory Tract Infection in Hangzhou.

BACKGROUND: Since the outbreak of COVID-19, China has undertaken a variety of preventative and control measures, effectively reducing the incidence of numerous infectious diseases among the pediatric population in Hangzhou. We aim to investigate the genetic and epidemiological characteristics of Human parainfluenza virus-3 (HPIV-3) in pediatric patients during this period. METHODS: A total of 1442 pharyngeal swab samples were collected from outpatients and inpatients with a diagnosis of acute respiratory tract infections (ARTIs) from November 2020 to March 2021. HPIV-3 was detected by quantitative real time polymerase chain reaction (qRT-PCR). The L gene of HPIV-3 positive samples was amplified and sequenced. RESULTS: Among 1442 children with ARTI, the positive rate of HPIV-3 was 7.07% (102/1442). The positive detection rate was the highest in the 6-month to 1-year age group. Coinfection was observed in 36 HPIV-3-positive samples (35.29%, 36/102), and adenovirus (ADV) was the most common coinfecting virus (63.89%, 23/36). The L gene of 48 HPIV-3 positive samples was sequenced. The nucleotide sequence analysis showed high consistency (92.10%-99.40%), and all strains belonged to C3a. CONCLUSIONS: During study periods, the positive detection rate of HPIV-3 among children is high, and the highest proportion of coinfection was observed in HPIV-3 mixed ADV infection. Phylogenetic analysis revealed that the nucleotide sequence of the L gene of HPIV-3 was highly consistent, and the main epidemic strain in this area was the C3a subtype.

Characteristics and Outcomes of Mycoplasma Pneumoniae Pneumonia Associated with Pulmonary Embolism and Necrotizing Pneumonia in Children.

Purpose: To explore the clinical characteristics, treatment, and long-term prognosis of mycoplasma pneumoniae pneumonia (MPP) combined with pulmonary embolism (PE) in children. Patients and Methods: The medical records of 16 children who were diagnosed with MPP associated with PE between January 2016 and January 2023 at Children's Hospital, Zhejiang University School of Medicine were retrospectively reviewed. Results: The average age patients were 8.24 ± 1.99 years. All cases were diagnosed with refractory mycoplasma pneumoniae pneumonia (RMPP) and presented complications in the form of necrotizing pneumonia (NP). The main symptoms observed were cough and fever (n = 16, 100%), chest pain (n = 8, 50%), dyspnea (n = 8, 50%), and hemoptysis (n = 4, 25%). In these cases, 12 patients had involvement of the pulmonary artery, 3 patients experienced issues with the pulmonary vein, and 1 patient had simultaneous involvement of both the pulmonary artery and pulmonary vein. Among the 12 pulmonary artery embolism cases, 6 involved the right pulmonary artery, 4 involved the left pulmonary artery, and 2 involved both the right and left pulmonary arteries. The mean D-dimer level was 8.50 ± 4.76 mg/L. All patients received anticoagulant therapy, and after treatment, there was a significant improvement in their symptoms and lung lesions. Conclusion: Children with RMPP, chest pain, hemoptysis, and elevated D-dimer levels should be closely monitored for the potential development of PE. The co-occurrence of MPP and PE often involves the presence of NP. In cases of confirmed PE, anticoagulation therapy may be a suitable consideration. PE and NP resulting from MPP generally had a favorable overall prognosis.

Identification of mycoplasma pneumonia in children based on fusion of multi-modal clinical free-text description and structured test data.

Mycoplasma pneumonia may lead to hospitalizations and pose life-threatening risks in children. The automated identification of mycoplasma pneumonia from electronic medical records holds significant potential for improving the efficiency of hospital resource allocation. In this study, we proposed a novel method for identifying mycoplasma pneumonia by integrating multi-modal features derived from both free-text descriptions and structured test data in electronic medical records. Our approach begins with the extraction of free-text and structured data from clinical records through a systematic preprocessing pipeline. Subsequently, we employ a pre-trained transformer language model to extract features from the free-text, while multiple additive regression trees are used to transform features from the structured data. An attention-based fusion mechanism is then applied to integrate these multi-modal features for effective classification. We validated our method using clinic records of 7157 patients, retrospectively collected for training and testing purposes. The experimental results demonstrate that our proposed multi-modal fusion approach achieves significant improvements over other methods across four key performance metrics.

An unusual presentation of necrotizing pneumonia caused by foreign body retention in a 20-month-old child: A case report and literature review.

Necrotizing pneumonia (NP) is a rare but serious complication that occurs after foreign body retention. We report a case of severe NP in an infant caused by foreign body retention in the airway with no choking history. After a timely tracheoscopy and effective antibiotic treatment, her initial clinical symptoms were alleviated. However, she subsequently exhibited pulmonary manifestations of necrotizing pneumonia. To reduce the risk of NP from foreign body aspiration, for patients with airway obstruction and asymmetrical opacity of both lungs, timely diagnostic bronchoscopic evaluation is essential.

Clinical features of Streptococcus intermedius infection in children: a case series study.

Introduction: Streptococcus intermedius is an opportunistic pathogen associated with prolonged hospital stays and high mortality rates in adults. However, little is currently known about the clinical features of Streptococcus intermedius infection in children. Methods: This retrospective case series study included 40 children diagnosed with Streptococcus intermedius, confirmed through bacterial cultures or high-throughput sequencing. Antibiotic resistance was assessed through susceptibility testing. The site and clinical manifestations were evaluated for all patients. Results: The common infection sites were the abdominal cavity, skin and soft tissue, intracranial, and invasive pulmonary, with the abdominal cavity being the most frequently affected. The drug susceptibility test showed 100% sensitivity to ceftriaxone, levofloxacin, chloramphenicol, vancomycin, and linezolid, 92.6% sensitivity to penicillin, 73.3% resistance to erythromycin, and 76.7% resistance to clindamycin. Besides antibiotic therapy, surgical intervention or pus drainage was often necessary. Lung imaging of four patients revealed pulmonary abscesses, nodules, or encapsulated pleura. Two cases yielded positive culture results, while three were identified as positive through high-throughput nucleotide sequencing of pleural effusion. Discussion: In children with Streptococcus intermedius infection, emphasis should be placed on the risk of pus or abscess formation. In cases of pulmonary abscess and pleural effusion, especially in male children, Streptococcus intermedius should be suspected even if the culture is negative. Improvements in high-throughput nucleotide sequencing are required to reduce misdiagnosis rates.

Causal relationship between outdoor atmospheric quality and pediatric asthma visits in hangzhou.

Many air pollutants and climate variables have proven to be significantly associated with pediatric asthma and have worsened asthma symptoms. However, their exact causal effects remain unclear. We explored the causality between air pollutants, climate, and daily pediatric asthma patient visits with a short-term lag effect. Based on eight years of daily environmental data and daily pediatric asthma patient visits, Spearman correlation analysis was used to select the air pollutants and climate variables that correlated with daily pediatric asthma patient visits at any time (with a lag of 1-6 days). We regarded these environmental variables as treatments and built multiple- and single-treatment causal inference models using the Dowhy library (a Python library for causal inference by graphing the model, quantitatively evaluating causal effects, and validating the causal assumptions) to estimate the quantitative causal effect between these correlated variables and daily pediatric asthma patient visits in lag time. The multiple-treatment causal inference model was a model with 8 treatments (Visibility, Precipitation, PM10, PM2.5, SO2, NO2, AQI and CO), 1 outcome (daily pediatric asthma patients visits), and 5 confounders (Humidity, Temperature, Sea level pressure, wind speed and unobserved confounders "U"). Single-treatment causal inference models were 8 models, and each model has 1 treatment, 1 outcome and 12 confounders. Spearman correlation analysis showed that precipitation, wind speed, visibility, air quality index, PM2.5, PM10, SO2, NO2, and CO were significantly associated variables at all times (p < 0.05). The multiple-treatment model showed that pooled treatments had significant causality for the short-term lag (lag1-lag6; p < 0.05). Causality was mainly due to SO2. In the single-treatment models, visibility, SO2, NO2, and CO exhibited significant causal effects at any one time (p < 0.05). SO2 and CO exhibited stronger positive causal effects. The causal effect of SO2 reached its maxima (causal effect = 11.41, p < 0.05) at lag5. The greatest causal effect of CO appeared at lag3 (causal effect = 10.67, p < 0.05). During the eight year-period, the improvements in SO2, CO, and NO2 in Hangzhou were estimated to reduce asthma visits by 8478.03, 3131.08, and 1341.39 per year, respectively. SO2, NO2, CO, and visibility exhibited causal effects on daily pediatric asthma patient visits; SO2 was the most crucial causative variable with a relatively higher causal effect, followed by CO. Improvements in atmospheric quality in the Hangzhou area have effectively reduced the incidence of asthma.

A missed foreign body aspiration masquerading as congenital pulmonary airway malformation in a nine-year-old boy: A case report and literature review.

Although airway foreign body aspiration (FBA) is a common occurrence in any age group, unrecognized and retained foreign bodies in lungs may result in severe complications, such as lung abscess or bronchiectasis. In rare cases, FBA may present with similar clinical features as many other diseases (e.g. asthma, tumor, pulmonary eosinophilia). Here, we report a rare case of missed FBA in a nine-year-old boy, whose chest CT scan was suggestive of a cavitary lesion in the left lower lobe mimicking congenital pulmonary airway malformation (CPAM). However, surprisingly, flexible bronchoscopy revealed a peanut lodged in the lateral basal segment of left lower lobe, which was subsequently retrieved by a forceps and avoided unnecessary surgical lobectomy. Therefore, FBA can mimic other disorders (e.g. CPAM), and a high index of suspicion and additional diagnostic techniques (e.g. flexible bronchoscopy) may be required to distinguish them. Additionally, FBA should be considered in the differential diagnosis of respiratory disorders in children even lack of aspiration history.

Case report: Primary alveolar soft-part sarcoma of the lung in a child.

Alveolar soft-part sarcoma involving the lung is mostly metastatic in nature, while primary alveolar soft-part sarcoma involving the lung occurs more rarely. Herein, we report a rare case of a patient with primary alveolar soft-part sarcoma of the lung, which may represent the earliest onset of this condition reported thus far. In this patient, surgery was performed to excise the lesion to the greatest extent possible, and the combination of surgery with chemoradiotherapy and an antiangiogenic agent may provide an important reference for the development of standard or first-line treatment for such pediatric patients.

Successful management of tracheal lobular capillary hemangioma with arterial embolization followed by electrosurgical snaring via flexible bronchoscopy in an 11-year-old boy: A case report and literature review.

Lobular capillary hemangioma (LCH), previously known as pyogenic granuloma, is a benign vascular lesion commonly found within the oral and nasal cavities. However, it is rarely encountered within the trachea, especially in pediatric patients, where it manifests as hemoptysis, cough, and wheeze, and is frequently misdiagnosed as bronchitis or asthma. There is limited literature on the presentation, behavior, and management of tracheal LCH. Herein, we describe a rare case of tracheal LCH in an 11-year-old boy with a history of hemoptysis, which was successfully managed with arterial embolization followed by electrocautery loop snaring via flexible bronchoscopy. No complications occurred during and after the procedure. A review of the relevant literature is also provided. Our case is unique, given the therapeutic strategy utilized for pediatric tracheal LCH, and reminds physicians to be aware of tracheal LCH in the differential diagnosis for hemoptysis.

Mild Encephalitis/Encephalopathy with Reversible Splenial Lesion Associated with Scrub Typhus in a Child: A Case Report.

Background: Mild encephalitis/encephalopathy with a reversible splenial lesion (MERS) is a rare clinicoradiological syndrome characterized by transient mild encephalopathy and magnetic resonance imaging (MRI) findings of a reversible lesion in the splenium of the corpus callosum (SCC). Multiple causes have been proposed for the pathogenesis of MERS, with infection as the most pre-eminent. Case Presentation: We report the case of a 10-year-old girl with MERS due to scrub typhus. Her clinical manifestations of headache and drowsiness, together with lesions involving the SCC, as shown by MRI, and their complete resolution upon follow-up fulfilled the diagnosis of MERS. At the same time, the characteristic eschar of the skin and the positive Weil-Felix test result confirmed the existence of scrub typhus infection. Conclusions: To the best of our knowledge, we described the first pediatric case of MERS associated with scrub typhus. The case indicated that an MERS patient with fever should be considered as possibly having a scrub typhus infection. The characteristic black eschar of scrub typhus generally occurs after bite of mite that is important and useful to the doctor for making proper diagnosis.