Clinical characteristics of children with multisystemic inflammatory syndrome associated with COVID-19 Clinical characteristics of MIS-C associated with COVID-19

Aim: Coronavirus disease 2019 (COVID-19) has become a public health threat to people all over the world in 2020 and 2021. The Centers for Disease Control and Prevention (CDC) and WHO (World Health Organization) have named a novel disease multisystem inflammatory syndrome in children (MIS-C). Herein we aimed to present a group of pediatric patients with MIS-C, who were followed up in our clinic. Material(s) and Method(s): We retrospectively reviewed the medical records of patients who were followed up at our University Hospital with the diagnosis of MIS-C between January 2021 and May 2021. Result(s): The mean age of 9 patients was 87.4 +/-17.8 years (range 6-161 months);six of the patients were male. All patients had fever at admission. The duration of the fever was between 3 and 7 days. Four patients (44.4%) had terminal ileitis on ultrasonic examination. The laboratory tests of the patients revealed leukocytosis in 4 (44.4%) patients, anemia in 5 (55.5%) patients, thrombocytopenia in 1 (11.1%) patient, and a high CRP level in 8 (88.8%) patients. All patients had high sedimentation rates and procalcitonin levels. One (11.1%) patient was operated on for terminal ileitis. All patients were treated with steroids (1-2 mg/kg prednisolone) and IVIG (2gr/kg). Patients who needed ICU admission were also treated with vasoactive drug infusion (intravenous dopamine). Discussion(s): There is a need for increased awareness among pediatricians that MIS-C should come to mind, especially in patients with long-lasting fever and signs and symptoms that resemble Kawasaki disease.Copyright © 2022, Derman Medical Publishing. All rights reserved.

Status dystonicus in a patient with cerebral palsy and COVID-19.

Introduction: status dystonicus (SD) is a rare condition characterized by generalized and intense exacerbation of muscle contractions. Objective(s): to present a pediatric patient with SD associated with COVID-19. Case report: 3-year old male with cerebral palsy. He was admitted to the emergency room after four days with respiratory symptoms, which were accompanied by increased muscle tone, generalized dystonia, and febrile seizures. In laboratory tests, COVID-19 was confirmed, as well as an elevation of creatine phosphokinase (CPK), 16,000 U/L. Diagnosis of SD is established, recovering after receiving medical management. Conclusion(s): SD can cause serious complications, so it is essential to identify possible triggers in patients with greater susceptibility.Copyright © 2022 Authors. All rights reserved.

Acquired hemophilia in a patient with SARS-CoV-2 infection, a case report

Acquired hemophilia (AH) is a potentially life-threatening hemorrhagic disorder. We report the second confirmed case of COVID-19-associated AH in a 45-year-old female which, unfortunately, expired as her treatment failed. She presented to the emergency department with abnormal bleeding and spontaneous hemoptysis about ten days after a removal surgery of her epiglottis tumor. Aggregation tests, such as partial thromboplastin time (PTT), are recommended in patients with COVID-19 infection that have bleeding episodes.Copyright © 2022 The Author(s);Published by Society of Diabetic Nephropathy Prevention.

Seasonal Trend of Viral Prevalence and Incidence of Febrile Convulsion: A Korea Public Health Data Analysis.

Febrile convulsion (FC) is the most common seizure disease in children, which occurs with a fever. We investigated the Korean Health Insurance Review and Assessment Service data of patients aged between 6 months and 5 years at the time of FC diagnosis. Diseases that can cause seizures with fever, such as neoplasms, metabolic disorders, nervous system disorders, cerebrovascular diseases, perinatal problems, and congenital abnormalities, were excluded. Weekly virus-positive detection rate (PDR) data were obtained from the Korea Disease Control and Prevention Agency for adenovirus, parainfluenza virus, respiratory syncytial virus (HRSV), influenza virus, coronavirus (HCoV), rhinovirus (HRV), bocavirus, metapneumovirus (HMPV), rotavirus, norovirus, and astrovirus. Using the Granger test, we then analyzed the monthly PDR and investigated the association between FC incidence and monthly PDR. We additionally identified monthly and seasonal FC incidence trends using the autoregressive integrated moving average. Between 2015 and 2019, 64,291 patients were diagnosed with FC. Annually, the incidence was the highest in May and the lowest in October. Most patients were diagnosed during the spring (26.7%). The PDRs for HRSV, HCoV, HRV, HMPV, and norovirus were associated with FC incidence after 1 month.

Medical Education in Times of Pandemic: To Practice or to Protect?

Introduction: In the beginning of March 2020 with first case of COVID-19 reported in Turkey, measures that were assumed to decrease the spread of SARS-CoV-2 were taken quickly. Use of personel protective equipments and limiting number of people contacting with the patients were some of the most important precautions. Although these precautions protected medical student from risk of infection, they limited their practical learning oportunities and probably negatively effected their education. Aim of our study was to measure the effect of pandemic on medical education of grade 6 medical students. Material(s) and Method(s): We had 6th grade medical students that finished their education between July 2020 and June 2021 fill out a questionnaire that measures their self-esteem on evaluation and procedural practice in pediatric patients and presents their subjective opinions on this period and their solution suggestions with closed and open ended questions. Result(s): Forty nine grade 6 student was included in the study. Their self-esteem was average (general competency in pediatric patients was 2.31+/-0.94 and general self reported competency in clinical practices was 2.65+/-1.42). The practice they feel most confident was hand washing (4.44+/-1.16), and the practice the feel least confident was establishment of vascular access (1.94+/-1.09). When they were asked to evaluate their self-competency in pediatric patients from 1 to 5,the procedure they most frequently observed was establishment of vascular access (74%) and least frequently observed was lumbar puncture (12%). Most frequently performed procedure was urinary catheterization (20%). 80.9% them stated that they felt unlucky to be 6th grade in COVID-19 pandemic and they would like to have more opportunities to contact with the patients with personal protective equipment (PPE). Conclusion(s): Education of 6th grade medical students affected negatively with decreasing number and diversity of patients and limited opportunity to evaluate patients and observe and perform procedures. Improvements should be made in pediatric departments to increase possibility of student to encounter patients and continue hands on learning with the right precautions. Copyright © 2022, Galenos Publishing House. All rights reserved.

A case of post coronavirus disease 2019 (COVID-19) multisystem inflammatory syndrome in adults (MIS-A) presenting as fever and seizures

Background/Purpose: The coronavirus disease 2019 (COVID-19) pandemic has led to the emergence of a severe associated condition, multisystem inflammatory syndrome in adults (MIS-A). Initially identified in children as MIS-C, literature regarding the clinical manifestations, illness progression, and treatment of MIS-A are limited. Method(s): This study describes a case of MIS-A presenting as fever and seizures. She was initially given steroids and IVIG, and due to recurrence of fever, she was later treated with tocilizumab. Result(s): The patient was a 55-year- old Filipino female presenting to the emergency department with five days of fever, headache, and disorientation. Lumbar tap was done, which showed elevated opening pressure, normal leukocyte count, normal glucose, slightly elevated protein, and no microorganisms. She was admitted and managed as a case of viral encephalitis. On hospital day 6, she had sudden onset of head-jerking and further decrease in sensorium, hence she was transferred to the intensive care unit. Brain MRI was unremarkable, and subsequent immune-mediated encephalitis was considered. The patient underwent methylprednisolone pulse therapy and IVIG infusion, which provided immediate improvement of sensorium and resolution of fever episodes. Her condition stabilized, and she was transferred out of intensive care. She underwent physical and occupational rehabilitation as preparation for discharge. Two weeks after infusion therapy, on hospital day 26, patient had recurrence of fever episodes and persistence of elevated inflammatory markers. The patient had reported a previous COVID-19 infection 10 weeks prior to admission and received a booster dose of Moderna (Spikevax) COVID-19 vaccine three weeks prior. She tested positive for ANA (1:640, nuclear speckled), while the rest of the autoimmune antibody tests were negative. She was diagnosed as MIS-A based on the following: documented fever (>=38 degrees centigrade) for >=24 hours prior to hospitalization;new-onset neurologic signs and symptoms including seizures and encephalopathy in a patient without prior cognitive impairment;elevated CRP, ferritin, IL-6, and ESR;and a positive SARS-CoV- 2 test for recent infection by RT-PCR. Patient was treated with a locally available monoclonal antibody, tocilizumab, which was given on hospital day 43. Following infusion, she had lysis of fever and marked decrease in CRP, ferritin, IL-6, and ESR. Patient was discharged improved and without end-stage organ damage. Conclusion(s): Immunomodulators target hyperinflammation seen in MIS-A. There may be a role for the use of tocilizumab via blockage of IL-6. MIS-A remains a topic for research, particularly its disease characteristics, management, and relation to a dysregulated immune system.

A Rare Case of Covid 19 Presenting As Generalized Tonic Clonic Seizures

Introduction: Coronavirus disease 2019 (COVID-19) is a novel coronavirus that was frequently isolated from Wuhan, China in patients with respiratory tract infections. The most prevalent symptoms are fever and respiratory tract involvement. In this paper, seizures, an uncommon manifestation of the condition, is described. Case Discussion: A previously healthy 34-year-old female was taken to the emergency room with a widespread tonic-clonic seizure. Five days prior to admission, the patient complained of fever, cough, headache, widespread weakness, and myalgias. She experienced two episodes of convulsions around one hour ago. The MRI of the brain was normal, whereas the CT of the chest indicated localised ground-glass opacities. Using real-time PCR, the respiratory material was positive for COVID-19. The patient's symptoms improved after using anticonvulsive and antiviral drugs. Conclusion(s): To our knowledge, this is one of the rare case studies reporting a link between frequent seizures and COVID-19. Copyright © 2023 Wolters Kluwer Medknow Publications. All rights reserved.

Evaluation of Coronavirus Disease 2019-Positive Patients with Febrile Convulsions

Objective: Febrile convulsion is a common seizure type in children between 6 months and 6 years of age and is seen in 2%-5% of children.1 Coronavirus disease 2019 spread rapidly and became a pandemic. As coronavirus disease 2019 can be seen in epilepsy patients, the relationship between coronavirus disease 2019 and seizures is not clear yet.2 This study aimed to evaluate the characteristics of coronavirus disease 2019-positive patients with febrile convulsions and compare them with coronavirus disease 2019-negative patients with febrile convulsions regarding their clinical features.Methods: Forty patients were included in the study. In our country, diagnosing, monitoring, and treating coronavirus disease 2019 are performed according to the Turkish Ministry of Health coronavirus disease 2019 Scientific Committee guidelines.Results: Twelve of the patients were coronavirus disease 2019 positive, whereas 28 were coronavirus disease 2019 negative. While the rate of complex febrile convulsion was 50% in the coronavirus disease 2019-positive group, this ratio was 25% in the coronavirus disease 2019-negative patient group.Conclusions: Seizures occur in the presence of higher-grade fever in coronavirus disease 2019-positive cases. On the other hand, the probability of seizures to occur focally and recur during the same disease period might be higher. Male gender and maternal history of febrile convulsions may be the risk factors.

CEC01-03 Safety of vaccines: a current perspective

Vaccines are powerful tools for preventing infection or disease from the infectious pathogens they target, but they may induce additional effects unrelated to the intended targets. Similar to other pharmaceutical products, vaccines may cause side effects, but tolerance to these is extremely low due to the use of vaccines in healthy people, particularly children. Redness, swelling or soreness at the site of injection are common for many vaccines under the term of reactogenicity. High fever can be present at a rate of 1/100 to /100 000 as can fever-induced convulsions from vaccines such as measles, mumps or rubella. Rotavirus vaccines are suspected to be associated with intussusception in about 1/100 000 first doses. Allergic reactions are in the same range. The massive H1N1 vaccination in the world has also been potentially associated with an increase in narcolepsia in patients with a risk allele. More recently, the SARS-CoV-2 vaccine ChAdOx1 nCov-19 have been found to cause a thromboembolic complication termed vaccine-induced immune thrombotic thrombocytopenia in very few people. Consequently, vaccines must undergo vigorous assessment before and after licensure to minimize safety concerns. Potential safety concerns should be identified as early as possible during the development for vaccines. In this CEC, along with courses, the attendees will have to work in small groups on real case studies associating non-clinical development and regulatory strategies. Copyright © 2022 Elsevier B.V.

Clinical And Laboratory Characteristics Of Covid-19

The significance of D-dimer coagulation (DD), prothrombin time (PT), activated partial thromboplastin time (APTT), thrombin time (TT) and fibrinogen (Fg) and PCT in predicting the severity and prognosis of COVID-19 was studied. Violation of the function of blood coagulation occurred in almost all, more often in severe patients. Indicators of hemostatic homeostasis, such as D-dimer, prothrombin time, fibrinogen and procalcitonin, can be used as predictors of disease severity in patients. Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.

Central Nervous System Infiltration in Chronic Lymphocytic Leukemia: A Study on Behalf of the Registro Brasileiro De Leucemia Linfocitica Cronica

Introduction: Central nervous system (CNS) infiltration in chronic lymphocytic leukemia (CLL) is a rare presentation of CLL that can potentially have disastrous complications. Reported prognosis is poor. The objective of this study is to report a series of cases of CLL with CNS infiltration. Method(s): This is a case-series of a Brazilian CLL registry (Registro Brasileiro de Leucemia Linfocitica Cronica). We included patients with CLL and CNS infiltration. This is a descriptive study. Result(s): A total of 10 (0.28%) in 3610 patients were identified with confirmed (80%) or suspected (20%) CNS infiltration. Median age at CLL diagnosis was 57.5 y/o (range: 50 - 76). Three (30%) patients were diagnosed with CNS infiltration concomitantly with the CLL diagnosis, while others (70%) were diagnosed at a median of 41 months of CLL diagnosis (range: 11 to 119 months). Only three (30%) patients had been previously treated for CLL. Most common symptoms of CNS infiltration were convulsion (30%), altered mental status (30%), headaches (30%), ophthalmologic (30%), and urinary incontinence (20%). Amnesia, asthenia, vomiting, hemiparesis, cervicalgia, and dizziness were also present (one patient each). Of the patients with confirmed CNS infiltration, diagnoses were performed through liquor exam (all patients) and biopsy (one patient). Of the two patients with suspected CNS infiltration, one achieved complete response and the other, partial clinical response, following instituted CLL-directed therapy with (1 patient) or without (1 patient) intrathecal chemotherapy. Of the other 8 patients, 3 achieved complete response, 2 failed treatments, 1 was not evaluated and 2 had missing information. Of all patients, 5 are alive, 3 died of sepsis, multiorgan failure following CNS methotrexate-related toxicity, and COVID, and 2 had missing information. Discussion(s): Our results show that the prognosis of CNS infiltration in CLL can be relatively good, with at least 50% of patients alive at 1 year. However, a series of 18 patients published by Strati et al has shown a poorer outcome, with half of the patients dead at 1 year. Although all patients were diagnosed by liquor exam, that same study reported a low specificity for liquor exam in CLL (42%) due to the frequent presence of leukemic cells in the cerebrospinal fluid in other conditions. Establishing CNS CLL as the cause of the symptoms can be difficult, since up to 70% of patients with CLL have CNS infiltration in autopsy studies, and our results may be superestimated. In summary, CNS infiltration in CLL is a rare event, and further studies are needed to address prognosis and management. Copyright © 2022

TH-207. A particular case of Sturge weber syndrome revealed in adulthood, implications of the COVID-19 era

Sturge weber syndrome (SWS) is a rare angiomatosis described in the pediatric population. There are only few cases with a late revelation in adulthood. We report a particular adult case of SWS revealed after a second dose of mRNA-COVID-19 vaccination. A 61-year-old man with cardiovascular factors presented with a set of escalating neurological symptoms (blurred vision, hemiparesis, headaches, CBH, convulsions, movement disorders) a month after he received his second dose of the Pfizer-BioNTech COVID-19 vaccine. Susceptibility weighted imaging on brain MRI showed enlarged transmedullary veins in the right parieto-occipital lobes as well as contrast enhancement of the same localization after gadolinium injection compatible with the diagnosis of cerebral angiomatosis. Lumbar puncture revealed a slight elevation of protein. Multiple EEGs and a video-monitoring EEG showed alternate, predominantly right hemisphere seizures not always accompanied by clinical manifestations. The evolution was marked by refractory seizures to anti-epileptic drugs and movement disorders only stabilized after 10 g of methylprednisolone. A complete panel of investigations was done to look for autoimmune or infectious encephalitis, metabolic encephalopathy, and systemic malignancy but all were negative. Clinical presentation of SWS includes a wide range of neurological symptoms (stroke-like episodes, migraine, blurred vision, seizures, etc.). Our patient had many of these symptoms and is classified as a type III SWS on the Roach Scale. However, the presence of movement disorders in this condition is not reported. The worsening of the patient under anti-epileptic medication was another red flag to the diagnosis of isolated SWS. Since the patient's recovery was only obtained after immunosuppressive therapy and no biological evidence of any other etiology of encephalopathy was found, the hypothesis of an autoimmune encephalitis on a fragile brain triggered by COVID-19 vaccination was the most probable explanation to this presentation. Throughout this case, we wanted to report another case of late-onset SWS meanwhile highlight the importance of further exploration of the possible connection between COVID-19 vaccination and autoimmune encephalitis. Copyright © 2022

The evaluation of accesses for febrile and afebrile seizures in the pediatric emergency department during COVID-19 lockdown

We aimed to evaluate the admissions to the Pediatric Emergency Department (PED) due to seizures one year before and one year after the first COVID-19 case in Turkey. We divided the admission time into two: The prelockdown period (March 2019-February 2020) and the lockdown period (March 2020 - February 2021). We divided the seizures into six parts: First simple febrile convulsion (FK), first complex FK, recurrent simple FK, recurrent complex FK, first non-febrile seizure, and recurrent non-febrile seizure. We compared the prelockdown and lockdown periods in terms of demographic and clinical characteristics and monthly admission of patients. The total number of patients admitted to PED was 37.323 and 10.191 during the prelockdown and lockdown period, respectively. While seizure-related PED accesses were 918 during the prelockdown period, 508 patients were admitted to PED during the lockdown period. Monthly average admissions decreased in all seizure types during the lockdown period. The ratio of first simple febrile seizures to total seizures decreased from 22.4% (206/918) to 16.3% (83/508), while the ratio of first afebrile seizures to total seizures increased from 29.6% (272/918) to 36.8% (186/508). While the rate of first febrile seizures decreased, we observed a significant increase in the rate of first afebrile seizures. The findings suggested that risk factors such as depression/anxiety or screen exposure may have caused seizures in patients with a predisposition to seizures. Copyright © 2022 Ondokuz Mayis Universitesi. All rights reserved.

Immediate Adverse Events Following COVID-19 Vaccination in Australian Pharmacies: A Retrospective Review.

BACKGROUND: Four COVID-19 vaccines are approved for use in Australia: Pfizer-BioNTech BNT162b2 (Comirnaty), AstraZeneca ChAdOx1 (Vaxzevria), Moderna mRNA-1273 (Spikevax), and Novavax NVX-CoV2373 (Nuvaxovid). We sought to examine the type and management of immediate adverse events following immunisation (I-AEFI) after COVID-19 vaccination. METHODS: Retrospective review of I-AEFI recorded between July 2021 and June 2022 in 314 community pharmacies in Australia. RESULTS: I-AEFI were recorded in 0.05% (n = 526/977,559) of all COVID-19 vaccinations (highest: AstraZeneca (n = 173/161,857; 0.11%); lowest: Pfizer (n = 50/258,606; 0.02%)). The most common reactions were: (1) syncope, after the first dose of AstraZeneca (n = 105/67,907; 0.15%), Moderna (n = 156/108,339; 0.14%), and Pfizer (n = 22/16,287; 0.14%); and (2) Nausea/vomiting after the first dose of Pfizer (n = 9/16,287; 0.06%), Moderna (n = 55/108,339; 0.05%), and AstraZeneca (n = 31/67,907; 0.05%) vaccines. A total of 23 anaphylactic reactions were recorded (n = 23/977,559; 0.002%), and 59 additional I-AEFI were identified using MedDRA® terminology. Pharmacists primarily managed syncope by laying the patient down (n = 227/342; 66.4%); nausea/vomiting was managed primarily by laying the patient down (n = 62/126; 49.2%), giving water (n = 38/126; 30.2%), or monitoring in the pharmacy (n = 29/126; 23.0%); anaphylactic reaction was treated with adrenaline (n = 18/23; 78.3%) and n = 13/23 (56.5%) anaphylactic reactions were treated with the combination of: administered adrenaline, called ambulance, and laid patient down. CONCLUSION: The most commonly recorded I-AEFI was syncope after COVID-19 vaccination in pharmacy; I-AEFI are similar to those previously reported. Pharmacists identified and managed serious and non-serious I-AEFI appropriately and comprehensively.

EARLY DESCRIPTIVE STUDY OF PEDIATRIC ED VISITS FOR COVID-19 DURING THE OMICRON WAVE IN QUEENS, NY

SESSION TITLE: Studies on COVID-19 Infections Posters SESSION TYPE: Original Investigation Posters PRESENTED ON: 10/18/2022 01:30 pm - 02:30 pm PURPOSE: Two years into the COVID-19 pandemic, knowledge about how infection affects children is still lacking. Unlike adults, prior to the recent surge widespread symptomatic childhood illness has not been seen, likely due to school shutdowns, strict social distancing, and less severe illness course. During the omicron surge in NYC, an increase in pediatric cases was noted likely due to reinstatement of in-person learning and relaxing of social distancing. Though vaccines were available, only 9% of children aged 5-11 years and 35% of adolescents aged 12-17 years were vaccinated. During omicron surge, a large proportion of adult patients positive for COVID-19 were asymptomatic. We aimed to explore incidence of ED visits, hospital admissions, vaccine status and presenting complaints in pediatric population who tested positive for COVID-19 during the omicron surge in NYC. METHODS: A retrospective chart review was conducted of patients <18 years who tested positive for COVID-19 at two multiethnic community hospitals during the Omicron wave (Nov 1, 2021-Feb 28, 2022). Demographics, vaccine status, reason for visit, diagnosis and disposition were extracted from EHR. Data were analyzed according to age group: 0 to <5 years (G1), 5 to <12 years (G2) and 12 to <18 years (G3). RESULTS: During this time, close to 2800 patients tested positive for COVID-19 at presentation to the ED or during hospitalization. Of these, 343 were <18 years of age (~10%). Overall, 53% of these pediatric patients were male. Ethnic make-up mirrored that of our community (approx. 60% Hispanic, 20% Asian, 10% Black). Admission status included 27 (7.8%) admitted to our hospitals, 18 (5.2%) transferred to other hospitals from our ED, and 298 (87%) treated and released from the ED. By age group, 183 (59%) were in G1, 76 (24%) in G2 and 51 (17%) in G3. Patients in G1 were <5 years and therefore ineligible for vaccine. Only 5% of G2 and 33% of G3 were fully vaccinated. In all groups, majority of patients presented for symptoms of viral infection (G1>80%, G2>90%, G3>90%). Symptoms of upper respiratory infection were most frequent in all groups (>80%). Convulsions (4.3%, 1.3%), croup (8.2%, 2.6%) and otitis media (3.3%, 1.3%) were noted in G1 and G2, respectively. In G3, acute appendicitis, diabetic ketoacidosis, and otitis media were present on admission in 2% each. Majority of patients requiring admission were from G1 (74%). CONCLUSIONS: Though adults during the recent surge often presented with asymptomatic COVID-19, pediatric patients in our sample typically presented for viral illness. It is difficult to interpret vaccine data except to say that there was a small group of pediatric patients who were symptomatic despite vaccination. CLINICAL IMPLICATIONS: We present early descriptive data from the Omicron surge in NYC in a pediatric sample. DISCLOSURES: No relevant relationships by Won Baik-Han No relevant relationships by Tamana Bismillah No relevant relationships by Kelly Cervellione no disclosure on file for Gagan Gulati;No relevant relationships by LOCHANA KC No relevant relationships by Lily Lew

A Folk Remedy for a Bellyache

Introduction: This case describes a curious cutaneous finding with a unique etiology from a cultural remedy. Case Description: A 19-month-old female was brought in by ambulance for an acutely progressive abdominal rash. Three days prior to presentation, she had a febrile seizure. The next day, she continued to have low grade temperatures and developed a faint red rash on the abdomen. On the day of presentation, the mother found a dark violaceous rash on the abdomen and called 911. The patient's presenting vital signs were unremarkable except for tachycardia to 133 and lower blood pressure for age of 86/67. She was tired and irritable. She had a large welldemarcated dusky and dark plaque with central denudation over the whole abdomen and right lateral back [Figures]. She was exquisitely tender to light palpation and guarding her abdomen. The remainder of her exam was unremarkable. Given the extent of her skin injuries, differential included intra-abdominal injury, intra-abdominal hemorrhage, burn or bruise from accidental and non-accidental cause, allergic dermatitis and disseminated intravascular coagulation in the setting of sepsis. Laboratory evaluation revealed mildly low hemoglobin for age at 10.5 g/dl with low MCV 74.2fL and a leukocytosis with WBC of 18.41 x10-3 πl with neutrophil predominance. Coagulation factors were normal. CMP revealed mild acidosis with CO2 of 17 mmol/L. Imaging studies included normal: CT head and CT abdomen with mild subcutaneous edema in the anterior abdomen near the umbilicus. Additional infectious studies were negative including nasal SARS-CoV-2 PCR, blood culture and urine culture. After the work-up, findings were consistent with a second-degree burn confirmed by Dermatology and Plastic Surgery. Suspected Child Abuse and Neglect team conducted additional social history with maternal grandmother because she is the caretaker when parents are at work, given parental denial of witnessing or causing the burn. Grandmother had limited English proficiency, so history was taken using a Medical Spanish interpreter. Grandmother explained that one day prior to presentation, she used an Oaxacan folk remedy to alleviate abdominal pain in which green tomato pulp was applied like a salve. Final diagnosis was second degree burn from phytophotodermatitis. Patient's skin improved with daily dressing changes and application of silver sulfadiazine, and she was discharged home to parents. Discussion: The use of tomato salve is a unique etiology of phytophotodermatitis that has not been well-characterized. Typical vegetation that causes burn injuries include figs, lemons and common wildflowers. Tomatillos or green tomatoes contain plant psoralens that can induce a strong phototoxic reaction to ultraviolet A radiation exposure after cutaneous contact. Conclusion: We present this case to highlight the importance of conducting thorough social history in the family's preferred language and to share a unique folk practice that can present as a severe burn and mimic child abuse.

Recurrence of adverse events of special interest after COVID-19 vaccines rechallenge: A Vigibase® study

Introduction: Since the beginning of vaccination against COVID-19 in 2020, the occurrence of adverse events of special interest (AESI) after the 1st dose of vaccine raises the question of the potential risk associated with the following injections. Real-life vaccine data collected in pharmacovigilance databases can provide information about the safety of a rechallenge with COVID-19 vaccines. In order to help physicians to decide whether another injection is at risk, we analyzed the cases reported in the WHO pharmacovigilance database, Vigibase®. Material and methods: We identified AESI with major concerns about the safety of a rechallenge with COVID-19 vaccines: facial paralysis, immune thrombocytopenia, herpes viral infections, hypertension, hearing loss, Guillain-Barré syndrome (GBS), convulsions, myelitis, encephalitis, myocarditis, pericarditis and acute pancreatitis. We extracted cases with rechallenge of these AESI from VigiBase®, whether the AESI recurred or not, until 24 November 2021. The rate of recurrence of the initial AESI according to the vaccine platform was calculated. Results: 676 cases of AESI with COVID-19 vaccines reported information of recurrence after rechallenge, 320 with positive recurrence and 356 with no recurrence. Facial paralysis, herpes viral infection, GBS and myocarditis mostly did not reccur whatever the vaccine type. Whereas hypertension, hearing loss, convulsion and pericarditis seemed to reoccur only after rechallenge of mRNA vaccines, compared to others vaccines. There were few data for immune thrombocytopenia, encephalitis, myelitis and acute pancreatitis. Discussion/Conclusion: This study provided information about the safety of rechallenge of COVID-19 vaccines after first occurrence of AESI. Such information is of great importance considering that several booster shots are being proposed to populations to improve protection against COVID-19 variants. In case of AESI after COVID-19 vaccine, the decision to maintain the following dose must take into account the patient's individual risk benefit balance as well as his history. Although limited, our results provide clinical elements that may help decision-making.

Hemiconvulsion-Hemiplegia-Epilepsy Syndrome in the Setting of COVID-19 Infection and Multisystem Inflammatory Syndrome in Children

Objective: To present a case of Hemiconvulsion-Hemplegia-Epilepsy (HHE) Syndrome in a child with COVID-19 infection and Multisystem Inflammatory Syndrome in Children (MIS-C). Background: HHE Syndrome is a rare pediatric epilepsy syndrome that presents with prolonged unilateral convulsive status epilepticus in the setting of fever, followed by hemiparesis, unilateral hemispheric swelling and atrophy, and the development of epilepsy. Though it was first described over six decades ago, the pathophysiology is still poorly understood with multiple factors contributing, including hyperthermia, inflammation, and cytotoxic edema from prolonged ictal activity. Prognosis is variable, from the resolution of hemiplegia and seizures to permanent hemiparesis and refractory epilepsy. Design/Methods: This is a case report based on a chart review. Results: The patient is a 2-year-old boy with a history of one prior complex febrile seizure who presented with greater than one hour of convulsive status epilepticus in the setting of fever. The patient had a generalized tonic-clonic seizure with more prominent convulsions on the right side. The patient required intubation and was initially given multiple anti-seizure loads though continued to have persistent electrographic and electroclinical seizures. EEG showed lefthemispheric high amplitude spike/polyspike and wave discharges. The patient required continuous midazolam infusion with eventual control of seizures on levetiracetam, phenobarbital, and clobazam. The examination was notable for persistent right-sided hemiparesis with gradual improvement. MRI brain without contrast revealed T2 signal abnormality and restricted diffusion diffusely throughout the left cerebral hemisphere. Infectious workup was significant for positive COVID-19 PCR and elevated inflammatory markers, consistent with MIS-C. Conclusions: Our patient had prolonged focal convulsive status epilepticus in the setting of acute febrile illness secondary to COVID-19 and MIS-C leading to hemiparesis and diffuse left cerebral hemisphere edema on MRI brain consistent with HHE syndrome. More research is needed to elucidate further HHE syndrome's pathophysiology and assess long-term outcomes in patients with HHE syndrome.

Evaluation of Patients Presenting to the Pediatric Emergency Department with Seizures during the COVID-19 Pandemic

The coronavirus disease 2019 pandemic has led to significant changes in hospital visits worldwide. The admission rates have remarkably decreased. This study investigates the characteristics of 104 patients (54 girls, 50 boys) who presented to our pediatric emergency department (ED) with seizures during the pandemic between May 2020 and May 2021. Regarding seizure type, 84 generalized and 20 focal seizures had occurred. Tonic, tonic-clonic, clonic, and hypomotor seizures were seen in descending order. Thirty-seven patients were diagnosed with epilepsy, and 32 patients with first afebrile, 25 first febrile, and 10 recurrent febrile seizures. No patients had acute symptomatic seizures. In 85 patients, the seizures had stopped before the ED visit;only one lasted >60 minutes. Benzodiazepines were administered as a first-line drug. Demographical features, electroencephalogram (EEG), and cranial imaging findings, laboratory test results, and distribution by month and by the hour of ED visit were analyzed. Study data was in accordance with the literature by seizure types, seizure management, and cranial imaging rates but differed by distribution in terms of month and the hour of ED visit. The EEG abnormality rate was higher among the first afebrile seizure cases. The number of patients with seizures was 69, that is, 0.3% of emergency admissions, for the 4 months of 2019 before the pandemic, and 104, that is, 0.4% of emergency admissions for the whole initial year of the pandemic thereafter. So, the number of patients with seizures had decreased, but their rate had increased, which could be attributed to a decrease in the number of nonurgent presentations to the ED during the pandemic.