Objectives Clinical presentation of pediatric celiac disease (CD) is heterogeneous and ever-evolving. Our aim is to highlight its changes throughout the years. Methods Data about clinical presentation of CD in children diagnosed between 1990 and 2020 at the CD Center of Maggiore Hospital, Bologna, were collected. Patients were stratified into groups based on the date [P1 (1990–2011), P2 (2012–2020)] and age [G1 (< 2 years), G2 (2–5), G3 (6–11), G4 (12–18)] at diagnosis, then investigated by comparing CD clinical presentation in different periods and ages. Results 1081 children were selected. Mean age at diagnosis increases from 5.9 to 6.6 years from P1 to P2. Gastrointestinal Symptoms (GIs) are predominant, with a decline of diarrhea (47%VS30%) and an increase of constipation (4%VS19%) (p < 0.001). Among Extraintestinal symptoms (EIs) a decrease of anemia (76%VS43%, p = 0,001) is observed. Failure to Thrive (FTT) is stable throughout the years (p = 0.03), while screenings show a trend of increment (19%VS23%). GIs’ frequency decline from G1 to G4 (p = 0,001), with reduction of diarrhea (p < 0.001), and rise of recurrent abdominal pain (p = 0,02). EIs are more frequent at older ages, FTT in younger patients. Conclusions Changes in clinical presentation of CD have occurred in the last 30 years. We observe a reduction of severe and classic gastroenterologic symptoms and a rise of atypical ones, together with a growth of serological screenings and higher age at diagnosis. Awareness about CD clinical trends is crucial for a proper approach and early diagnosis.

A 6-year-old African boy with multi-viral infection including parvovirus B19 and severe acute respiratory syndrome coronavirus 2 was admitted for persistent fever associated with respiratory distress and myocarditis complicated by cardiogenic shock needing ventilatory and inotropic support. Coronary aneurysms were also documented in the acute phase. Blood tests were suggestive of macrophage activation syndrome. He was treated with intravenous immunoglobulins, aspirin, diuretics, dexamethasone, hydroxychloroquine, and prophylactic low molecular weight heparin. Normalization of cardiac performance and coronary diameters was noticed within the first days. Cardiac magnetic resonance imaging, performed 20 days after the hospitalization, evidenced mild myocardial interstitial oedema with no focal necrosis, suggesting a mechanism of cardiac stunning related to cytokines storm rather than direct viral injury of cardiomyocytes.

Diet is a matter of interest in the pathogenesis and management of Crohn’s Disease (CD). Little is known about CD children’s dietary habits. Our aim was assessing the quality and the amount of nutrient intake in a group of CD pediatric patients. Data were compared with those of healthy subjects (HS). In total, 20 patients (13 males) and 48 HS (24 males) aged 4–18 years were provided with a food diary to fill out for one week. Winfood software performed the bromatological analysis, providing data about intakes of proteins and amino acids, fatty acids, carbohydrates, cholesterol, fibers, minerals, vitamins, and polyphenols. Estimates of the antioxidant activity of foods and of the dietetic protein load were also calculated. The diet of CD patients was poorer in fibers, polyphenols, vitamin A, beta-carotene, and fatty acids, and richer in animal proteins, vitamin B12, and niacin. PRAL was higher in CD patients’ diets, while ORAC was higher in HS. No significant differences were observed in carbohydrate and other macro- and micronutrient consumptions. CD dietary habits seem to reflect the so-called Western diet, possibly involved in CD pathogenesis. Furthermore, analysis of dietary habits allows for prevention of nutritional deficiencies and timely correction through education and supplementation.

Contrary to adults, in children severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is mostly pauci-asymptomatic.Nevertheless, outbreaks of pediatric multisystemic illness overlapping with Kawasaki disease (KD) or KD-like have been described in pandemic areas, defining a new entity: multisystem inflammatory syndrome in children (MIS-C). 1 We observed two children with clinical and laboratory features of MIS-C, a direct link with SARS-CoV-2 hospitalization, serology showed positive SARS-CoV-2 IgG. Notably, the father had presented an influenza-like illness 3 weeks before and had identical serology. The diagnosis was reconsidered as MIS-C. Interestingly, both patients showed the same rash (not erythema multiforme, consisting of fixed macules with dusky central discoloration, but annular erythema, with polycyclic lesions with central clearing, as in our cases). Dermatological involvement in MIS-C has been reported in approximately 60% of cases, but poorly described, mainly as "maculopapular rash", although some published pictures of skin lesions are very similar to ours, suggesting that this could be a recurrent pattern in MIS-C. To date, given the paucity of welldetailed skin lesions, no correlation is known about this pattern and the prognosis of MIS-C. 1,2 The shorter duration of cutaneous manifestations in case 1, who received IVIG, may be related to the hypothesized superantigenic activity of SARS-CoV-2 S glycoprotein, comparable to other antigen targets of IVIG antibodies. 3 The few published cases of MIS-C maculopapular eruptions' skin biopsies show perivascular dermatitis with lymphocytic infiltrate and vasculitis. Our findings seem to support what was previously hypothesized: cutaneous manifestations, just as visceral involvement, may depend not only on the direct effect of viral injury, but also on the immune responses and cytokine storm secondary to infection. 4,5