Health burdens associated with poor housing and indoor pest infestations are likely to affect young children in particular, who spend most of their time indoors at home. We completed environmental assessments in 644 homes of pregnant Latina women and their children living in the Salinas Valley, California. High residential densities were common, with 39% of homes housing > 1.5 persons per room. Housing disrepair was also common: 58% of homes had peeling paint, 43% had mold, 25% had water damage, and 11% had rotting wood. Evidence of cockroaches and rodents was present in 60% and 32% of homes, respectively. Compared with representative national survey data from the U.S. Department of Housing and Urban Development, homes in our sample were more likely to have rodents, peeling paint, leaks under sinks, and much higher residential densities. The odds of rodent infestations in homes increased in the presence of peeling paint [odds ratio (OR) 2.1; 95% confidence interval (CI), 1.5–3.1], water damage (OR 1.9; 95% CI, 1.2–2.7), and mold (OR 1.5; 95% CI, 1.0–2.1). The odds of cockroach infestation increased in the presence of peeling paint (OR 3.8; 95% CI, 2.7–5.6), water damage (OR 1.9; 95% CI, 1.2–2.9), or high residential density (OR 2.1; 95% CI, 1.2–3.8). Homes that were less clean than average were more prone to both types of infestations. Pesticides were stored or used in 51% of households, partly to control roach and rodent infestations. These data indicate that adverse housing conditions are common in this community and increase the likelihood of pest infestations and home pesticide use. Interventions to improve housing and promote children’s health and safety in this population are needed.

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From 2011 Pediatric Rheumatology Symposium sponsored by the American College of Rheumatology Miami, FL, USA. 2-5 June 2011Purpose Castleman's disease (CD) is an uncommon lymphoproliferative disorder, eventually complicated with paraneoplastic pemphigus (PNP) and pulmonary involvement. The association of Behçet and CD is very rare and the outcome is worse when PNP is present. MethodsWe describe a 17 yo female patient with Behçet's syndrome and CD. She was affected by a 4-month history of severe oral and genital ulcers, bilateral uveitis and abdominal pain. A CT scan of the abdomen showed the presence of a retroperitoneal mass (9,4 x 9,0 x 7,4 cm). On the basis of histological and immunohistological findings, a diagnosis of CD, hyaline vascular type, was formulated. There was no lymphadenopathy, fever or anemia. One month later, oral ulcers turned into desquamative plaques, Nikolsky sign was observed and an oral biopsy diagnosed paraneoplastic pemphigus. Ca 125 and Ca 19-9 levels were elevated. The patient developed an acute pleuritic pain with dyspnea, image exams revealed pneumomediastinum, pneumothorax and subcutaneous emphysema, and a bronchoscopy revealed a tracheal lesion suggestive of pemphigus. No signs of infection were present and pulses of methylprednisolone were prescribed, with good initial response. After the surgical excision of the retroperitoneal mass (June, 2010), she developed progressive dyspnea and a pulmonary function test revealed a mixed respiratory disorder. A thoracic CT scan showed patchy areas of ground-glass opacity. Thromboembolism was excluded. She was treated with high doses of prednisolone, colchicines, cyclosporine 200mg/day, with no response. Extensive mucosal erosions were still present, the tumor markers kept on rising and she presented a severe pulmonary restriction. We decided to initiate Tocilizumab EOW associated with moderate dose of prednisone. ResultsAfter 5 months of Tocilizumab use, the oral lesions were considerably better, but there were only a subtle increase of forced vital capacity and little (if some) pulmonary clinical response. A PET scan failed to show new tumor lesions. Although most patients with the benign type of CD have shown remission of PNP upon excision of the tumor, our patient showed severe pulmonary involvement despite of IL6 blockage treatment. ConclusionAlthough the association of Behçet's disease and pemphigus is very intriguing, CD should always be investigated in a young patient with PNP. Localized hyaline-vascular CD is generally benign, fully responding to surgery. However, the presence of PNP with pulmonary involvement carries a poor prognosis.

Background Uveitis is a common manifestation of rheumatic diseases with a broad spectrum of clinical presentation. It can be acute or chronic, affect any part of the uveal tract, can occur before or after the diagnosis of the associated rheumatic condition and can progress with severe complications. In Juvenile Idiopathic Arthritis (JIA) it tipically involves the anterior chamber, is frequently oligosymptomathic and carries a high rate of complications. Objectives Analyze the course and the development of uveitis associated with rheumatic diseases in outpatients of the Rheumatic Clinic of Hospital Universitário Clementino Fraga Filho (HUCFF) at Universidade Federal do Rio de Janeiro between 2000 and 2010. Methods We conducted a retrospective study based on review of medical records of 37 patients in the Rheumatology Clinic of the HUCFF. The selected patients had a previous diagnosis of uveitis and were enrolled to our service between 2000 and 2010. Results Twenty-six patients (70,3%) presented with a rheumatic disease, while 11 (29,7%) patients had isolated uveits. The most frequent diagnosis was JIA (56,8%), followed by idiopathic uveitis (29,7%) and the spondyloarthritis was diagnosed in 8,1%. In most cases, the uveitis presented in the course of the underlying disease (56,8%), as it was the involvement of the anterior chamber of the eye (70,3%). Of these 37 patients, there were a total of 57 affected eyes and 92% had a chronic presentation. The presence of antinuclear antibodies (ANA) was associated with higher frequency of uveitis and most patients with positive ANA developed complications (65%). The most frequent complications were cataract (30.2%) and posterior synechiae (13.2%). All patients who were on biological therapy presented some complication, what could be explained by the greater severity of uveitis in patients who require the use of these medications. Conclusions Juvenile idiopathic arthritis-related uveitis accounts for the majority of identifiable causes of childhood onset uveitis. The characteristics of uveitis associated with rheumatic diseases observed in this study were similar to those found by other authors. The rate and spectrum of vision threatening complications of pediatric uveitis are significant and the authors emphasize the importance of regular eye evaluation in rheumatic diseases. Disclosure of Interest None Declared