Conditions currently associated with erythema nodosum in Swiss children

A review was made of the 36 paediatric patients in whom the diagnosis of erythema nodosum had been established between 1977 and 1996 at the Department of Paediatrics, University of Bern, Switzerland. Infectious diseases were associated with erythema nodosum in 20 (including 10 streptococcal infections) and non-infectious inflammatory diseases in 8 patients. None of the 36 patients had tuberculosis or had been exposed to sulphonamides, phenytoin or hormonal contraceptives. There were eight patients in whom either the associated disease was not diagnosed, or there was no other disease. Conclusion Most cases of erythema nodosum are nowadays caused by non-mycobacterial infectious diseases or by non-infectious inflammatory disease

Wie wird das hamolytisch-uramische Syndrom des Kindesalters in der Schweiz erworben? [How is hemolytic-uremic syndrome in childhood acquired in Switzerland?]

Intestinal infections with shigatoxin-producing Escherichia coli or Shigella dysenteriae type I play a major role in the pathogenesis of the hemolytic-uremic syndrome in childhood. Escherichia coli has been repeatedly detected in the intestines of healthy cattle. Twenty-seven children with hemolytic-uremic syndrome were treated at our hospital between June 1990 and March 1997. Factors indicating a possible previous contact with bovine intestinal content were found in 18 out of the 27 patients: parents stockbreeders (n = 7), recent visit to a cowshed or contact with cowdung or manure (n = 5), residence in a rural cattle-breeding area (n = 5), or consumption of raw milk (n = 1). The factors mentioned were found in 5 out of 27 control patients (p < 0.01). Two children experienced hemolytic-uremic syndrome after a stay respectively in Egypt and Tunisia. Our results indicate an important source for acquisition of hemolytic-uremic syndrome in childhood. Observing simple hygienic rules such as washing of hands and pasteurization of milk is likely to have a positive influence on the incidence of this illness. There are also grounds to consider adding the hemolytic-uremic syndrome to the list of travel-related diseases

Pulmonary renal syndrome in childhood: a report of twenty-one cases and a review of the literature

In adults, the term specific pulmonary renal syndrome describes disorders with pulmonary and glomerular manifestations and includes Wegener's granulomatosis, Goodpasture disease, and systemic lupus erythematosus. Nonspecific pulmonary renal syndrome refers to either pulmonary disease complicating glomerular disease, or glomerular diseases following pulmonary disease. Since little is known regarding pulmonary renal syndrome in childhood, we reviewed the charts of 21 pediatric patients with pulmonary renal syndromes treated by the Department of Pediatrics, University of Bern between 1991 and 1998; we also reviewed the pediatric literature that deals with specific pulmonary renal syndromes. Specific pulmonary renal syndrome was noted in 3 children with systemic vasculitis (Wegener granulomatosis, N = 2; microscopic polyangiitis, N = 1) and 2 with systemic lupus erythematosus. Nonspecific pulmonary renal syndrome was observed in 12 patients with pulmonary edema (N = 9), pulmonary thromboembolism (N = 2), and pulmonary infection (N = 1) complicating the course of a glomerular disease, and in 4 children with a pulmonary disease followed by a glomerular disease. Review of the literature disclosed 52 cases of specific pulmonary renal syndrome other than systemic lupus erythematosus: Wegener granulomatosis (N = 28), Goodpasture disease (N = 13), and Henoch-Schönlein purpura (N = 11). In addition, hemolytic uremic syndrome complicated pneumococcal pneumonia in 32 cases. We conclude that pulmonary renal syndromes need to be looked for in childhood. Apart from Wegener granulomatosis, Goodpasture disease, and systemic lupus erythematosus, Henoch-Schönlein purpura and hemolytic-uremic syndrome occasionally have both pulmonary and renal features