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Introduction: Pediatric acute osteomyelitis (AO) is a serious condition and a challenging diagnosis. It mainly affects previously healthy individuals and Staphylococcus aureus is the leading causative agent. The objective of this study was to characterize all pediatric AO cases admitted to a second-level hospital during a six-year period. Methods: Retrospective single-center study, including all children under 18 years-old with a primary diagnosis of AO. Descriptive statistics analysis was performed. Results: Ten cases were identified, 60% males. The median age was 6.7 years. Previous trauma was referred by five. Affected locations were foot (n=3), tibia (n=3), femur (n=2), sacrum (n=1) and hand (n=1). All presented with local pain and limping or inability to walk (except one case with hand involvement). Four patients had fever and inflammatory signs, namely erythema and edema, were reported by four. At admission, nine had elevated inflammatory markers and six out of eight had normal radiographs. Magnetic resonance imaging confirmed the diagnosis in seven. Blood cultures were positive for Staphylococcus aureus (n=3) and Streptococcus pyogenes (n=1). Salmonella enteritidis was isolated from pus (n=1) and there was one presumed Kingella kingae AO defined as a positive polymerase chain reaction test from an oropharyngeal swab. The average duration of parenteral and oral antibiotherapy was 14.7 days 3.9 weeks, respectively. The antibiotic of choice was flucloxacillin. Two patients developed local complications. Discussion: An unspecific and subacute clinical and radiological presentation together with low positive blood culture rates difficults timely diagnosis and management. An early empirical parenteral antibiotherapy is mandatory, followed by an oral regimen for at least four weeks.

Henoch–Schönlein purpura (HSP) is characterized by nonthrombocytopenic palpable purpura, arthritis or arthral­gia, and gastrointestinal and/or renal involvement. Gastrointestinal symptoms are reported in 50%-75% and they are related to a previous group A streptococcal infection in 40%. A healthy 5-year-old girl presented with a three-week history of a recurrent purpuric rash on the lower limbs, ar­thralgia and angioedema, without renal involvement. During the third relapse, she had severe, diffuse and persistent abdominal pain and bloody stools. An abdominal ultrasound revealed transmural edema of the last ileal segment, compatible with ileitis. She received prednisolone for five days, with full clinical recovery. Antistreptolysin O titer was elevated. The remaining laboratory tests were normal (antinuclear, anti-neutrophil and anti-Saccharomyces cerevisiae antibodies; rheumatoid factor; stool cultures, parasitological examination and viral antigen tests). One month later, an abdominal ultrasound revealed no abnormalities. Terminal ileitis is a very rare complication of HSP in children but has a good prognosis.

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O impacto alimentar esofágico é uma situação que na maioria dos casos é secundária a patologia esofágica congénita ou adquirida, podendo constituir a primeira manifestação da doença. Descreve-se um rapaz, 11 anos, saudável, com sialorreia e dor retrosternal que surgiram subitamente durante o jantar. Foi submetido a endoscopia digestiva alta, que revelou um fragmento de carne impactado no terço distal do esófago (que foi extraído) e estrias longitudinais na mucosa. A análise histológica das biópsias esofágicas foi compatível com eosinofilia esofágica. Iniciou terapêutica com inibidor da bomba de protões com melhoria clínica e histológica. O diagnóstico diferencial das principais causas de impacto alimentar associadas a eosinofilia esofágica, nomeadamente esofagite eosinofílica, doença do refluxo gastroesofágico e eosinofilia esofágica respondedora a inibidor da bomba de protões, constitui um desafio clínico. Recebido: 15/10/2016 - Aceite: 11/12/2017