Recurrent lipoatrophic panniculitis of children.

BACKGROUND: Recurrent panniculitis in children with lipoatrophy has been loosely described and reported under different names, but has never been systematically evaluated by immunohistochemical stains. OBJECTIVE: To depict the profile of children with recurrent idiopathic panniculitis. METHODS: Study of clinical, histopathological and immunohistochemical features in five cases with recurrent idiopathic panniculitis. RESULTS: Five children with repeated attacks of painful subcutaneous nodules in association with fever, malaise and abdominal pain or arthralgia, with subsequent lipoatrophy were reviewed. In two patients, extensive involvement led to loss of the cutaneous fatty tissue. Laboratory abnormalities included increased acute phase reactants, leukocytosis with mild neutrophilia, microcytic anaemia and elevated liver enzymes. Histopathology showed lobar panniculitis without vasculitis and with a mixed infiltrate, composed of neutrophils, mononuclear cells, lymphocytes, macrophages and myeloid cells. Neutrophils and myeloid cells were more prominent in early lesions, whereas macrophages predominated in late stages, leading to lipophagia and lipoatrophy. Immunohistochemistry showed positive staining for myeloperoxidase around the necrotic adipocytes in early stages and CD68/PGM1 macrophages in late stages. Intense STAT1 staining was observed in the inflammatory infiltrate. All patients improved with methotrexate and corticosteroids. CONCLUSION: We present five cases of lobar panniculitis and lipoatrophy in childhood. The clinico-pathologic presentation shares features with other autoinflammatory diseases.

[Recommendations for the use of methotrexate in patients with juvenile idiopathic arthritis]. / Recomendaciones para el uso de metotrexato en pacientes con artritis idiopática juvenil.

OBJECTIVES: To develop a consensus document of recommendations for the use of methotrexate (MTX) in patients with juvenile idiopathic arthritis (JIA). MATERIAL AND METHOD: A group of eleven experts proposed several clinical questions on the use of MTX in patients with JIA. A systematic review was conducted and the evidence and recommendations for each question were extracted. The results were discussed and validated by the experts in a work session to establish the final recommendations. RESULTS: MTX is recommended as the first drug for inducing remission in JIA, and its indication should be made according to the clinical category of the patient. Prior to treatment, it is recommended to perform a complete blood count, including white cells, levels of liver enzymes, serum creatinine, and other analytical parameters according to specific risk factors. Treatment should be initiated with a dose of 10-15 mg/m(2)/week. In cases of uveitis or polyarthritis, an initial dose of 15 mg/m(2)/week should be considered. For a better bioavailability and tolerability, it is preferable to administer MTX parenterally if the dose is ≥15 mg/m(2)/week. It is necessary to periodically perform an analytical monitoring of the patient and to assess possible alterations in liver enzymes to make changes if necessary. Combinations with biological agents may be necessary, as well as the concomitant addition of folic or folinic acid. CONCLUSIONS: This document describes the main recommendations for the appropriate use of MTX in JIA patients, according to scientific evidence and clinical experience.

Malformación vascular de la rodilla simulando una artritis idiopática juvenil / Vascular malformation of the knee simulating juvenile idiopathic arthritis

No disponible

Meningitis bacteriana infantile. Revisión de 6 años (1996-2001) / No disponible

Objetivo. Determinar la prevalencia y etiología de la meningitis bacteriana infantil y el perfil de susceptibilidad antibiótica de sus agentes causales. Material y métodos. Estudio prospectivo de las meningitis bacterianas diagnosticadas en el laboratorio del Hospital Infantil Niño Jesús de Madrid en niños de edades comprendidas entre 10 días y 17 años, a lo largo de los años 1996-2001, y estudio comparativo de los resultados obtenidos con el quinquenio anterior. Resultados. Se identifican 127 meningitis bacterianas: 95 por N. meningitidis (56 de serogrupo B, 38 de C y 1 de W135), 16 por S. pneumonide, 6 por H. influenzae, 5 por M. tuberculosis y 5 por otras gérmenes. Test de susceptibilidad antibiótica: N. meningitidis 59% de las cepas sensibilidad disminuida a penicilina: S. pneumonia 66% de las cepas sensibilidad disminuida a penicilina: H. influenzae 80% β-lactamas positiva. Conclusiones. Predominio de N. meningitidis como agente causal (74,8%), siendo el serogrupo B el más frecuente (58,9%). El 59% de las cepas presentan sensibilidad disminuida a penicilina. En segundo lugar, S. pneumoniae (13%) con el 66% de las cepas con sensibilidad disminuida a penicilina. En tercer lugar, H. influenzae (5%), con descenso significativo asociado a la vacunación, todos ellos aislados en el año 1996 con un 80% de β-lactamasa positiva (AU)

Objetive. To determine the prevalence and etiology of bacterial meningitis in childhood and its profile of antibiotic susceptibility of agents. Patients and methods. Prospective study of bacterial meningitis diagnosed in the laboratory of Niño Jesús Infant Hospital of Madrid, in children between 10 days and 17 years-old, from 1996 to 2001, and comparative study of results obtains in the previous five year period. Results. 127 bacterial meningitis were identified: 95 by N. meningitidis (56 of serotype B, 38 of C and 1 of W135), 16 by S. pneumonia, 6 by H. influenza, 5 by M. tuberculosis and 5 by other germs. Antibiotic susceptibility test: N. meningitidis: 59% with low sensibility to penicillin; S. pneumonia: 66% with low sensibility to penicillin; H. influenza: 80% positive to β-lactamase. Conclusions. More frequency of N. meningitidis as etiologic agent (74,8%), being serotype B the major group (58.9%). 59% with low susceptibility to penicillin. Second place for S. pneumonia (13%) with 66% of low susceptibility to penicillin. Third place for H. influenczae (5%), with a significative decrease associated to vaccination, all of them detected in 1996 with 80% of β-lactamase positive (AU)

Subdural empyema with extension to vertebral canal secondary to salmonellosis in a patient with systemic lupus erythematosus.

CASE REPORT: A case of supratentorial subdural empyema extending to the superior subdural cervical space in a 14-year-old patient with systemic lupus erythematosus is presented. The presumed etiology of the empyema was an intestinal nontyphoidal salmonella infection. DISCUSSION: We review the neurological and neurosurgical complications in systemic lupus erythematosus.

[Reactive arthritis shortly after Streptococcus b-hemolyticus type A and Salmonella type B infection]. / Artritis reactiva tras infección reciente porestreptococo betahemolítico delgrupo A y Salmonella del grupo B.

We report the case of a girl aged 2 years and 8 months with monoarticular arthritis of the knee. Onset and outcome were slow. The child had suffered uncomplicated pharyngitis and a diarrheal process 1 and 2 weeks respectively prior to developing the disease. Additional data suggested the presence of reactive arthritis after Streptococcus infection. Salmonella was also detected in the feces. Unlike rheumatic fever, post-streptococcus reactive arthritis does not follow Jones' criteria and the clinical course is slow. Because gastrointestinal infection with both Streptococcus and Salmonella occurred simultaneously, the interaction between both agents, each of which alone can cause reactive arthritis, might have produced a synergic action in our patient.

[Childhood cutaneous polyarteritis nodosa]. / Panarteritis nudosa cutánea infantil.

Cutaneous polyarteritis nodosa is a form of polyarteritis nodosa. It is a rare disease in children and is characterized by its benign and chronic course. There is no evidence of hypertension or organ dysfunction. The aim of this study was to present a case of cutaneous polyarteritis nodosa and to review the literature. We describe the case of a 3-year-old male child with multiple, red, painful, edematous nodules of the extremities and trunk. Dermatologic findings were accompanied by fever and arthritis. Laboratory findings showed an acute phase response associated with raised antistreptolysin titer. Diagnosis was based on biopsy of the affected skin lesion in which necrotizing arteritis of the lower dermis with neutrophilic and eosinophilic infiltrates was found. The patient responded well to corticosteroid therapy. The evaluation of children with cutaneous polyarteritis nodosa should include laboratory studies to detect streptococcal infection.

Panarteritis nudosa cutánea infantil / Childhood cutaneous polyarteritis nodosa

La panarteritis nudosa (PAN) cutánea es una forma de poliarteritis nudosa, rara en niños, caracterizada por su curso benigno y crónico. No hay evidencia de hipertensión ni disfunción orgánica. El objetivo de este artículo es presentar un caso más de PAN cutánea y realizar una revisión bibliográfica. Se describe el caso de un niño de 3 años de edad, con múltiples nódulos enrojecidos, dolorosos y edematosos en las extremidades y tronco. Los hallazgos cutáneos estuvieron acompañados de fiebre y artritis. Los hallazgos de laboratorio mostraron unos reactantes de fase aguda y título de antiestreptolisina elevados. El diagnóstico se realizó con biopsia de la lesión cutánea, en las que se encontró arteritis necrosante en la dermis profunda con infiltrado de neutrófilos y eosinófilos. El paciente respondió de forma adecuada al tratamiento con esteroides. En la evaluación de los niños con PAN cutánea deben incluirse estudios para detectar infección estreptocócica (AU)

Artritis reactiva tras infección reciente por estreptococo betahemolítico del grupo A y Salmonella del grupo B / Reactive Arthritis shortly after Streptococcus B-Hemolyticustype a and Salmonella type B infection

Se expone el caso clínico de una niña de 2 años y 8 meses de edad que presentó monoartritis de rodilla de instauración y resolución lentas, poco después de haber presentado una faringitis aguda y un proceso diarreico entre 1 y 2 semanas antes, respectivamente. Los datos complementarios sugieren que se trata de una artritis reactiva tras una infección estreptocócica, demostrándose además Salmonella en heces. La artritis reactiva postestreptocócica, a diferencia de la fiebre reumática, suele tener un curso clínico lento y no cumple los criterios de Jones. La coincidencia en el tiempo con el padecimiento de una infección gastrointestinal por Salmonella plantea la posibilidad de que la asociación de ambos gérmenes, productores por sí mismos de artritis reactiva, posean una actuación sinérgica en el paciente referido (AU)

Primary solitary Echinococcosis in cervical spine. Postsurgical successful outcome after long-term albendazole treatment.

STUDY DESIGN: A case report of a young man with isolated cervical hydatidosis treated postoperatively with sustained cyclical albendazole therapy for 9 years of follow-up. OBJECTIVES: To communicate the efficacy and safety of prolonged albendazole treatment in the postoperative management of spinal hydatid disease, and recommend therapeutic regimes for preventing its recurrence. SUMMARY AND BACKGROUND DATA: Bone involvement in hydatid disease is uncommon and the cervical region of the spine is rarely affected. Surgical excision remains the treatment of choice but high rates of postoperative recurrence have highlighted the importance of adjuvant anthelmintic therapy. The selection of the drug(s) and the duration of the medical treatment is still controversial. METHODS: The patient described herein presented with isolated bone lesions, in an unusual cervical location, and without coincidental visceral involvement. Therefore, diagnosis was delayed and surgical debridement was carried out without any preoperative anthelmintic therapy. To prevent late recurrences, therapy with intermittent courses of albendazole has been maintained for nine years and is still ongoing. Response and toxicity related to therapy has been closely monitored by clinical, biochemical and radiological follow up. RESULTS: After surgery the patient has remained asymptomatic without sequelae or evidence of relapses. No clinically relevant side effects has been observed. CONCLUSION: Prolonged albendazole treatment appears to be safe and effective in the prevention of late recurrences after spine hydatidosis surgery. Long-term chemotherapeutic schedules should be considered after surgical excision of spine or bone lesions.