Early Treatment with Methylprednisolone Pulse Therapy Combined with Tonsillectomy for Heavy Proteinuric Henoch-Schönlein Purpura Nephritis in Children

Background: There is no clear consensus as to which patients with Henoch-Schönlein purpura nephritis (HSPN) at risk of a poor outcome should be treated and what therapeutic regimen should be used. Methods: Nine children with heavy proteinuric HSPN received prompt initiation of methylprednisolone pulse therapy (MPT) combined with tonsillectomy in a prospective study. Results: At presentation, the mean values for the patients’ urine protein excretion (early-morning urinary protein/creatinine ratio), serum IgA, activity index (AI), and chronicity index (CI) were 5.0 ± 5.6 g/g Cr, 135.6 ± 56.5 mg/dl, 4.0 ± 0.7, and 1.7 ± 1.3, respectively. At the second biopsy, conducted approximately 24 months after initiation of therapy, the patients’ serum albumin had significantly increased (4.4 ± 0.2, p Conclusions: Early treatment with MPT combined with tonsillectomy is effective in ameliorating the histopathological progression and improving the clinical course of children with heavy proteinuric HSPN

Low-fat Elemental Enteral Nutrition in the Management of Pediatric Acute Pancreatitis

Acute pancreatitis（AP）in childhood is rare, but is starting to be recognized more often. However, optimal enteral nutrition formulas for children with AP have not been determined. This report describes the successful management of AP, with low-fat elemental enteral nutrition, in a 5-year-old boy. The patient had been diagnosed with mild AP and started oral feeding after about 3 days of fasting, but his pancreatic enzyme levels subsequently became elevated. Therefore, to allow the pancreas to rest, total parenteral nutrition（TPN）was started. After starting TPN, there was no improvement in his pancreatic enzyme levels but, because his clinical symptoms were stable, a small amount of elemental diet was initiated. Elemental diet therapy was safely performed without return of any clinical symptoms and the patient’s pancreatic enzyme levels slowly improved. Elemental diet was both safe and beneficial, providing clinical remission and improvement in quality of life. Early elemental diet therapy may therefore be a useful treatment strategy for pediatric patients with AP

Emergence of Panton-Valentine leukocidin-positive ST59 methicillin-susceptible Staphylococcus aureus with high cytolytic peptide expression in association with community-acquired pediatric osteomyelitis complicated by pulmonary embolism

A 15-year-old boy, who had had a furuncle on his femur, developed femoral pyomyositis and osteomyelitis complicated by septic pulmonary embolism. Panton-Valentine leukocidin-positive (PVL+) ST59 methicillin-susceptible Staphylococcus aureus (MSSA) was isolated from pus and blood. Chemotherapy was started with cefazolin, followed by combination therapy with meropenem/vancomycin with surgery. The MSSA (strain KS1) was positive for increased levels of cytolytic peptide (psm alpha and hld) and staphylococcal enterotoxin B (SEB), and manifested IS1216V-mediated multidrug resistance (to erythromycin, clindamycin, kanamycin, streptomycin, and chloramphenicol), similar to a genome-analyzed reference strain (PM1) of ST59/SCCmecV(5C2&5) community-associated methicillin-resistant S. aureus (Taiwan CA-MRSA), but unlike another reference strain (M013) of Taiwan CA-MRSA in terms of resistance. The data suggest that CA-MSSA KS1, characterized by PVL, increased levels of cytolytic peptide, SEB, and multidrug resistance, is a possible ancestral strain of Taiwan CA-MRSA and causes the unique association of osteomyelitis and septic pulmonary embolism, requiring complicated management. Copyright (C) 2014, Taiwan Society of Microbiology. Published by Elsevier Taiwan LLC. All rights reserved