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Background - Covid-19 is less frequent and milder in children than in adults. However, cases of multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (MIS-C) have been reported in children, whose phenotype resembles atypical Kawasaki disease. Objectives - The paper describes the incidence as well as clinical, laboratory and radiological findings of MIS-C. Materials and methods - In the Paediatric Infectious Disease Centre of Palermo (Italy), a targeted surveillance for MIS-C from March 2020 to January 2021 was conducted. Case definition included WHO, UK and US criteria. Results - The paper reports the cases of 9 patients with MIS-C out of which 8 (88%) were hospitalized after September 2020. 44% were male and their median age was 6.5 years. Organ-system involvement included gastrointestinal (66%), cardiovascular (66%), mucocutaneous (88%), reticuloendothelial (77%) and respiratory (55%) systems. C-reactive protein (CRP), procalcitonin, D-dimer and pro-B-type natriuretic peptide levels (pro-BNP) were high in all patients. Chest radiography showed bilateral ground glass-opacities (55%) and pleural effusions (44%). Abdominal imaging findings included small-volume ascites (55%) and mesenteric lymphadenopathy (22%). Echocardiogram showed transient valves regurgitation (55%). In all the patients, the left ventricular ejection fraction was normal and coronary-artery aneurysms were not documented. They were treated with immunomodulating therapies. All patients neither received intensive care nor died. Conclusions - MIS-C represents a new systemic inflammatory syndrome with a phenotype resembling Kawasaki disease. MIS-C remains a rare condition, in which gastrointestinal and mucocutaneous involvement is predominant, nevertheless cardiovascular involvement must be investigated. MIS-C could be suspected even if SARS-CoV-2 exposure precedes the onset of the symptoms by more than 6 weeks. In most cases, a good prognosis might be expected.

Background: In Sicily, the first wave of COVID-19 showed a low epidemic impact in paediatric population, while the second and the third waves had a higher impact on clinical presentation of COVID-19 in children and a significantly higher severe outcome in patients with multisystem inflammatory syndrome in children (MIS-C), with a frequent life-threatening progression. Methods: We describe a cohort of 22 Sicilian children (11 M; 11 F; age: 1.4-14 years), presenting with clinical features compatible with MIS-C. Patients with negative swab had a history of recent personal or parental infection. Results: The following diagnostic criteria were detected: fever (100%); cheilitis and/or pharyngeal hyperaemia (86%); latero-cervical lymphadenitis (82%); rash (73%); abdominal pain and/or vomiting and/or diarrhoea (64%); conjunctivitis (64%); hands and feet oedema (18%). 59% showed cardiac involvement (6 pericardial effusion; 8 mitral valve insufficiency; 4 insufficiency of two valves; 3 coronary artery lesions CAL)). In all the patients, treatment was started within 72 hours after the admission, with IVIG (2 g/Kg/dose), methylprednisolone (2mg/Kg/day in 73% of patients; 30 mg/Kg/day for 3 days, followed by 2 mg/Kg/day in 27% of patients). 2 patients were treated with enoxaparin. TSS was described in 2 patients, who received additionally vasoactive drugs, albumin, diuretics. Cardiac involvement evolved into the complete resolution of lesions in most of the patients. All the patients were included in a follow-up, to investigate on clinical outcome and resolution of organ involvement. Cardiac valve insufficiency persisted only in 18% of children, CAL persisted only in 33% of children with coronary involvement, however without the evolution into aneurisms. Conclusions: The preferred treatment strategy was more aggressive at the diagnosis of MIS-C, to block the cytokine cascade. Most of our patients, in fact, received a first-line treatment with IVIG and steroids. This approach could explain the favourable prognosis, the rapid restoring of cardiac function also in patients with MAS or shock, and the good outcome during the 10 months follow-up in all the patients.

BACKGROUND To date, Coronavirus disease 2019 (COVID-19) remains a global health concern, with fatalities mostly in older age groups with underlying medical conditions, while children are less likely to manifest severe symptoms. CASE REPORT We describe the clinical cases of 2 brothers admitted to our Children's Hospital for persistent fever and cough during the COVID-19 pandemic. Case 1. A 1.5-year-old boy had fever, expiratory dyspnea, desaturation, oxygen saturation 94-96% with O2, and bilateral hissing and crackling rales. His interleukin-6 level in the acute phase of the disease was 100.41 and at the resolution it was 46.2 pg/ml. Treatment with amoxicillin plus clavulanic acid, methylprednisolone, and O2 allowed progressive improvement of clinical conditions and laboratory data. Case 2. A 3-month-old toddler was admitted to our hospital for fever, cough, and tachypnea, which started 2 days before hospitalization. He had fever, cough, conjunctivitis, mucous rhinorrhea, and 99% oxygen saturation on room air. Thorax auscultation showed whistles and buzzes. He had a positive molecular test result from a COVID-19 swab. Interleukin-6 levels during all the phases of the disease were

Background: the ongoing Coronavirus Disease 2019 (COVID-19) epidemic represents an unprecedented global health challenge. Many COVID-19 symptoms are similar to symptoms that can occur in other infections. Malaria should always be considered in patients with SARS-CoV-2 infection returning from endemic areas.Case presentation: we present the first case of multisystem inflammatory syndrome (MIS-C) and Plasmodium vivax-falciparum and SARS-CoV2 coinfection in children. Despite clearance of parassitaemia and a negative COVID-19 nasopharyngeal PCR, the patient’s clinical conditions worsened. The World Health Organization (WHO) criteria were used to make the diagnosis of MIS-C. Treatment with intravenous immunoglobulins and methylprednisolone was effective.Conclusions: this case emphasizes the importance of considering malaria diagnosis in patients returning from endemic areas, even in the COVID 19 era. Malaria and SARS-CoV2 co-infection may increase the risk of MIS-C, for which early detection is critical for proper management.

PRESENTAZIONE DEL CASO, STORIA CLINICA E SINTOMATOLOGIA R, 8 anni, sesso femminile. Nulla di rilevante all’anamnesi fisiologica e patologica remota. Bimba in sovrappeso (BMI 24,65 Kg/m2). Familiarità per neoplasia tiroidea (zia materna), tiroidite di Hashimoto e per neoplasie di altri organi. Un mese prima, tonsillite essudativa trattata con terapia antibiotica; simultaneamente comparsa di tumefazione laterocervicale dx non dolente; insorgenza di dolore e progressivo incremento del volume della tumefazione per veniva condotta in PS; all’EO: aspetto non sofferente, tumefazione laterocervicale di consistenza parenchimatosa dura, mobile nei piani sopra e sottostanti; linfoadenopatie multiple in sede laterocervicale bilateralmente;non epatosplenomegalia; all’ecografia del collo, formazioni ovalariformi disomogeneamente iperecogene, riccamente vascolarizzate (d.max 3x2cm); si disponeva ricovero c/o altra UO. IPOTESI DIAGNOSTICHE Linfoadenopatia reattiva-linfoma-patologia tiroidea (tiroidite? neoplasia?). INDAGINI DI I E II LIVELLO Nel sospetto di linfoadenopatia reattiva venivano eseguiti emocromo, indici di flogosi, tampone per SBEA, TAS, Ig per Bartonella, EBV, CMV, Mycoplasma, Adenovirus; si praticava terapia con claritromicina ed ibuprofene per 10 giorni; dato il persistere della sintomatologia e la negatività degli esami precedentemente citati, nel sospetto di malattia linfomatosa si eseguiva TAC-collo con evidenza di formazioni solide iperdense a livello della giugulare esterna (36x23 mm) e in regione paratiroidea bilateralmente (dmax 30 mm); linfoadenopatie laterocervicali diffuse, trachea improntata a dx e presenza di nodulo tiroideo nel lobo dx di circa 6 mm; immagine confermata dall’ecografia dove il nodulo appariva isoecogeno con orletto ipoecogeno. Venivano dunque eseguiti esami di funzionalità tiroidea con riscontro di TSH inferiore ai limiti di norma (0,041mg/dl), FT3-FT4 nei limiti, tireoglobulina elevata (7000ng/L), aumento di abTg (214Iu/ml). Calcitonina e anticorpi anti recettore-TSH nella norma. Si procedeva a esecuzione di biopsia linfonodale. Dopo asportazione linfonodale, riduzione della tireoglobulina (5000ng/L) DIAGNOSI ED EVENTUALE TERAPIA Alla luce dei valori di TSH quasi soppressi, seppur senza sintomatologia da ipertiroidismo, si iniziava terapia con metimazolo. All’esame istologico diagnosi di carcinoma tiroideo papillare; per volontà genitoriale, R. veniva condotta c/o Altro centro per il prosieguo della stadiazione ed intervento di tireodectomia. Segnaliamo questo caso per la rarità d’incidenza di carcinoma tiroideo in età pediatrica (incidenza: 0,5 casi/100000/anno) e per la necessità di considerarlo nella diagnosi differenziale di linfoadenopatia. L’associazione tra tiroidite e carcinoma tiroideo risulta essere frequente, è invece molto rara l’associazione con ipertiroidismo. Nel caso riportato, data la familiarità per neoplasie tiroidee potrebbe essere utile eseguire indagine genetica per gene BRAF.

Bronchiolitis is the most common disease of the lower respiratory tract occurring in children during their first year of life, becoming the most frequent cause of hospitalization. Although the disease can also be caused by other viruses, more than 70% of bronchiolitis cases are caused by respiratory syncytial virus (RSV). RSV bronchiolitis clinically presents rhinitis, coughing, increased breathing and eating difficulties; the symptoms are usually mild, but in some cases may be so severe as to require hospitalization. Diagnosis is mainly clinical and is based on a thorough medical history and a physical examination. Therapy is substantially of support, and has the aim of ensuring alimentation/hydration and optimal oxygenation. It has been recently noted that RSV infections may cause extra-pulmonary manifestations, including liver problems, as rarely described in the literature. The aim of this paper is to present three cases of RSV bronchiolitis in children with elevated transitory transaminase levels.

Acute osteomyelitis is a relatively rare disorder in the neonatal period, with considerable morbidity and mortality. Early diagnosis and prompt treatment are essential for a successful outcome. In this report we present a case of acute osteomyelitis of the talus due to methicillin-resistant Staphylococcus epidermidis, observed in a 30-day-old infant.

Intestinal intussusception is the invagination of an intestinal segment into another. Childhood intussusception is usually idiopathic, whereas adult intussusception is usually due to a definable intraluminal lesion or to a systemic disease. Although the aetiology of idiopathic forms often remains unclear, there is appreciable evidence to support an indirect role played by certain infectious agents. In this report we present a case of childhood intussusception probably due to adenovirus infection.