Osteoid osteoma mimicking monoarticular juvenile idiopathic arthritis in a girl

Osteoid osteoma (OO) is a benign osteogenic neoplasm, usually affecting children and young adults, that is typically characterized by nocturnal pain and response to non‐steroidal anti‐inflammatory drugs. OO is frequently misdiagnosed because it mimics juvenile idiopathic arthritis (JIA), bone infection or malignancy. Herein we report the case of a girl who presented with chronic monoarthritis of the knee mimicking JIA. After 1 year, OO of the femoral distal metaphysis was diagnosed. OO was treated with computed tomography‐guided radiofrequency ablation with disappearance of the symptoms and resolution of the neoplasm. No recurrences have been observed 3 years after the treatment. This case highlights that intra‐articular or juxta‐articular OO should be suspected in the case of misleading symptoms and signs, such as swelling, lack of typical pain and synovial thickening on ultrasound; needle biopsy of the lesion is necessary in the case of confusing imaging.     

Pott's puffy tumor in a 12‐year‐old boy

Pott's puffy tumor (PPT) is a rare complication of sinusitis characterized by subperiosteal abscess and osteomyelitis of the frontal bone. Early diagnosis and treatment is vital before it causes intracranial complications such as subdural empyema or brain abscess. Herein we describe the case of a 12‐year‐old patient who developed preseptal cellulitis and PPT, and was successfully treated with abscess drainage, sinus surgery and long‐term antibiotic therapy.     

Erythromelalgia with a linear pattern in a 12‐year‐old girl

Erythromelalgia is a rare clinical syndrome characterized by erythema, increased temperature, and severe burning pain that can be aggravated by warmth or relieved by cold. Erythromelalgia occurs either as a primary, idiopathic form, or secondary to a number of diseases and conditions. Although fairly well studied in adults, the characteristics, pathogenesis, and natural history are poorly characterized in the pediatric age group. Different therapeutic options have been tried, but no optimal treatment has been suggested for erythromelalgia. We report a rare case of linear erythromelalgia in a 12‐year‐old girl involving her central body from the peripheral extremities, which seemed to be secondary due to vasculitis. Clinical progress waxed and waned on maintenance aspirin and propranolol.     

Mask face: Bilateral simultaneous facial palsy in an 11‐year‐old boy

Bilateral facial paralysis is an uncommon clinical entity especially in the pediatric age group and occurs frequently as a manifestation of systemic disease. The most important causes are trauma, infectious diseases, neurological diseases, metabolic, neoplastic, autoimmune diseases and idiopathic disease (Bell's palsy). We report a case of an 11‐year‐old boy presenting with bilateral simultaneous peripheral facial paralysis. All possible infectious causes were excluded and the patient was diagnosed as having Bell's palsy (idiopathic). The most important approach in these cases is to rule out a life‐threatening disease.     

Demyelinating neuropathy in a 6‐year‐old girl with autism spectrum disorder

Herein we report the case of a 6‐year‐old girl with autism spectrum disorder (ASD) and weakness in the distal portion of the right upper limb. Although difficult to perform, nerve conduction studies indicated demyelinating neuropathy. Magnetic resonance imaging (MRI) showed swelling a nd high‐intensity signals in the right brachial plexus and cervical spinal roots. The symptoms recovered after a single course of i.v. immunoglobulin. Electrophysiological indices and MRI findings also improved after treatment. This case demonstrates the utility of neuroimaging in addition to electrophysiological assessments for the diagnosis of demyelinating neuropathy, particularly in young patients with ASD.     

Cat‐scratch disease with severe pleuritis in a 6‐year‐old girl

We present the case of a 6‐year‐old girl with cat‐scratch disease (CSD), who developed severe pleuritis without lymphadenitis. Bartonella henselae DNA was detected on real‐time polymerase chain reaction (PCR) analysis of whole blood. This is the first report of CSD diagnosed on real‐time PCR using whole blood.     

Acute aortic dissection mimicking acute abdomen in a 14‐year‐old boy

Aortic dissection is extremely rare in children. Although it usually presents with severe chest pain, atypical clinical presentations mimicking various illnesses may cause misdiagnosis. In this report, the case of a 14‐year‐old boy with symptoms suggestive of acute abdomen, which was finally diagnosed as aortic dissection, is discussed.     

Endoscopic papillary balloon dilation for a 7‐year‐old girl with choledocholithiasis

A 7‐year‐old girl was referred to our hospital for severe abdominal pain and elevated serum levels of amylase and aminotransferase. Radiological examinations revealed choledocholithiasis. EPBD was performed under intravenous anesthesia using midazolam and ketamine chloride. After fluoroscopic confirmation of a bile duct stone, a dilation balloon (30 mm‐long, 8 mm‐diameter) was passed over the guidewire and placed across the papilla. The balloon was gradually inflated until the notch created by the papillary sphincter disappeared. At 4 atm, the notch disappeared and the pressure was maintained for 15 s. Stone extraction was performed by using a retrieval balloon catheter. Abdominal pain disappeared immediately after EPBD, and she resumed oral intake 2 days after EPBD. In conclusion, EPBD may be a safe and effective technique for the treatment of choledocholithiasis in pediatric patients. EPDB should be selected as a treatment for pediatric choledocholithiasis in view of its advantages of preserving papillary function.     

Value conflicts in mothers' snack choice for their 2‐ to 7‐year‐old children

Value conflicts appear when people experience struggles, doubts, and feelings of guilt when making food choices. This study aims to provide insight into value conflicts, which mothers may experience while providing snacks to their young children. Mothers are mainly responsible for providing the snacks their young children eat, making it a big responsibility for them as children's dietary behaviour tracks into adulthood. Possible value conflicts Dutch mothers (n = 136) experience while providing snacks to their 2‐ to 7‐year‐old children were investigated using food and motivation diaries and semi‐structured interviews. Differences between mothers' educational level, first versus not‐first child, and the differences in age of the children were taken into account. Results showed that the younger the children, the more value conflicts the mothers experienced. Mothers experienced most value conflicts when they provided snacks perceived as unhealthy. Six main value conflicts are elicited by this study, namely, conflicts between healthy and unhealthy snacks; conflicts between healthy and convenient snacks; conflicts related to providing snacks just before dinner; conflicts related to influence of others; conflicts when the child asks but the mother says “no”; and conflicts related to many unhealthy snacks at parties or visits. The insights gained in this study can be used for interventions to promote a healthier lifestyle, support the design of new snack products, and can give guidance for marketing challenges in global snack markets.     

Collagenous gastroduodenitis with recurrent gastric ulcer in 12‐year‐old girl

This report describes a rare case of collagenous gastroduodenitis found in a 12‐year‐old Japanese girl who had recurrent hematemesis. Gastrointestinal endoscopy showed many lotus leaf‐like lesions on the gastric mucosa surrounded by atrophic gastric mucosa in the antrum, with a cobblestone appearance and a scarred duodenal ulcer in the duodenal bulb. A biopsy of the gastric mucosa indicated subepithelial collagen band. The patient was treated with H2‐blockers for her symptoms for 4 years following the endoscopic findings. Follow‐up endoscopy showed the same appearance as before. The pathology, however, showed a more prominent subepithelial collagen deposition. To make the correct diagnosis, it is critical to know from which part the pathological biopsy specimens were taken because there were numerous collagen bands in the atrophic membrane. It is important to monitor the patient regularly for evaluation of the etiology, pathogenesis and prognosis of this rare disease.