Case Report: Kawasaki Shock Syndrome With Polycyclic Eruption: A Peculiar Brain Imaging.

Kawasaki disease (KD) is a childhood vasculitis of unknown etiology. The present study describes a case of KD shock syndrome that occurred in an infant (age, 16 months) following 7 days of high fever and persistent rash characterized by target-like and purpuric skin lesions. The child developed neurological manifestations such as altered consciousness and irritability. Consequently, brain magnetic resonance imaging (MRI) was performed, revealing an inflammatory involvement of the anterior perforated substance and the hypothalamus. Cerebral involvement on brain MRI is rarely described in KD but when reported is characterized mostly by cerebral vasculitis. We illustrate for the first time in KD an inflammation in the brain not related to vasculitis, reporting peculiar neuroradiological findings. This last aspect has fascinated us in light of recent evidence about the immunological spectrum of Multisystem Inflammatory Syndrome in Children (MIS-C) and Kawasaki-like syndrome in the Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) outbreak.

Mild encephalopathy with reversible splenial lesion associated with echovirus 6 infection: a case report and review of the literature.

BACKGROUND: Mild encephalopathy with reversible splenial lesion (MERS), a clinic-radiological syndrome distinguished by reversible encephalopathy onset, has been increasingly recognized in Caucasian children. CASE: We describe a MERS case in a previously healthy 4-year-old girl admitted to the hospital with abnormal consciousness level, muscle weakness, dysphagia and dysarthria after a 4-day history of diarrhea and fever. Magnetic resonance imaging (MRI) of the brain showed hyperintensity in the corpus callosum splenium. Electroencephalogram was normal and cerebrospinal fluid (CSF) culture negative. The stool sample was positive for Echovirus 6 and serology test confirmed the infection. The child`s condition gradually improved and the MRI, after 15 days, depicted a normal brain. Only a mild speech impairment was persistent at discharge, which disappeared one month later. We performed a literature review about pediatric MERS cases demonstrating that infectious agents have been rarely isolated in CSF. CONCLUSION: MERS has an overall good prognosis independently from the treatment approach; this is confirmed by our case - one of the first reported with an Echovirus 6-related encephalopathy.

Vitamin D Levels in Active TB, Latent TB, Non-TB Pneumonia and Healthy Children: A Prospective Observational Study.

BACKGROUND: Growing evidence suggests that vitamin D deficiency might be implicated in the development of active tuberculosis (TB). We evaluated vitamin D levels in children with active TB compared to children with latent TB infection (LTBI), non-TB pneumonia (NTBP) and healthy controls to determine if there was a difference. METHODS: In this prospective study, vitamin D levels were measured and compared between the four groups and adjusted for age, ethnicity, gender and season of sample collection. RESULTS: Fifty-seven children were included: 24.6% active TB, 28.1% LTBI, 22.8% NPTB and 24.6% healthy controls. 36.8% of all children tested had an insufficient or deficient vitamin D level. Vitamin D level was significantly lower in active TB compared to other groups (p = 0.004). CONCLUSIONS: Our study showed a correlation between hypovitaminosis D and active pulmonary TB.