Introduction: Romania is one of the European countries with a significant burden of tuberculosis (TB). Although pulmonary TB is still highly prevalent, intestinal TB is very rare and remains a diagnosis of exclusion, especially in children. The authors aimed to raise the awareness on this pathology by discussing the challenges faced in the management of one difficult case. Case presentation: A 3-year-old boy was hospitalized in the Pediatrics Department of Grigore Alexandrescu Emergency Children's Hospital, Bucharest, Romania, for abdominal pain and melena. On clinical examination, he was malnourished, with generalized edema and marked abdominal distension. Laboratory tests revealed iron-deficiency anemia, low plasma proteins, inflammatory syndrome and high fecal calprotectin. The abdominal ultrasound showed bowel wall thickening and diffuse edematous mesentery; the colonoscopy described multiple ulcers with edematous margins. Parenteral nutrition and complex antibiotic treatment were initiated with no effect. During the hospital stay, the medical staff observed how the mother chewed the patient's food. The child's pulmonary X-ray was normal, but the mother's was suggestive for pulmonary TB. The QuantiFERON ® test was positive. Biopsy of the bowel mucosa revealed numerous granulomas; the Auramine O/Rhodamine B staining of the specimen was positive. Specific TB treatment was started with good results: the patient resumed growth, abdominal pain and distention disappeared. Conclusions: Intestinal TB poses a diagnostic challenge, especially in the absence of pulmonary disease. It may mimic many other intestinal pathologies. Since correct treatment depends on making the correct diagnosis, a high index of suspicion must be kept when facing atypical abdominal symptoms.

Introducere. Testul sudorii este metoda standard pentru diagnosticul fibrozei chistice (FC). Metoda conductivităţii reprezintă o alternativă ce nu este încă acceptată ca metodă de diagnostic, în ciuda corelării sale bune cu titrarea clorului (Cl-). Scopul lucrării este de a evidenţia valorile de referinţă ale acestei metode, diferită faţă de cele utilizate pentru metoda Gibson-Cooke şi de a aprecia capacitatea metodei conductivităţii de a discrimina pacienţii cu şi fără FC. Metode. Conductivitatea sudorii a fost determinată pentru 2.180 de pacienţi în cadrul Secţiei de Pneumologie a Spitalului clinic de Urgenţă pentru Copii "Grigore Alexandrescu" din Bucureşti în perioada ianuarie 2000iunie 2015. Diagnosticul de FC a fost stabilit pe baza manifestărilor clinice sugestive asociate cu două teste ale sudorii (TS) pozitive şi/sau cu testarea genetică. Testul a fost considerat pozitiv la o valoare ≥ 75 mmol/L, conform recomandărilor producătorului aparaturii utilizate (Wescor). Pacienţii au fost împărţiţi în trei loturi: primul lot a cuprins pacienţii la care s-au obţinut valori ≤45 mmol/L NaCl, al doilea lot, cei cu valori între 46 şi 65 mmol/L, iar cel deal treilea lot a cuprins pacienţii la care s-au obţinut valori > 65 mmol/L. Curba ROC a fost utilizată pentru a determina valoarea prag ce discriminează pacienţii cu şi fără FC. Rezultate. Nici un pacient cu FC nu a fost identificat în primul lot. În cel deal doilea lot a fost diagnosticat un pacient cu FC forma atipică. 80 de pacienţi cu FC au avut valori ale testului sudorii mai mari de 65 mmol/L, dintre acesţia, la 79 s-au obţinut valori mai mari ca 75 mmol/L. Valoarea prag pentru o predicţie optimă a diagnosticului de FC a fost stablită ca fiind de 76 mmol/l, cu o arie de sub curbă de 0,999, p<0,000, ceea ce încadrează metoda ca fiind excelentă în a depista pacienţii cu FC, cu o sensibilitate şi specificitate de 97%. Concluzie. Valorile conductivităţii sudorii sunt mai mari faţă de cele obţinute prin titrarea Cl-, aceasta fiind necesară şi obligatorie în cazurile echivoce.

Introduction. Important abdominal distension can be a challenge for both paediatricians and pediatric surgeons. Case presentation. Here, we report the case of a 3-year old child admitted to Pediatric Surgery Department for significant abdominal distension, food refusal and abdominal pain. He underwent radiological investigations; conditions like congenital megacolon and mechanical obstruction were excluded. At hospital admission, abdominal distension was minimal, but it became severe after episodes of air swallowing. Sleep bruxism and behavioural changes appeared also. An abdominal computerized tomography scan and barium swallow tests showed important distension of the stomach with excessive gas, a small intestine and colon. On upper endoscopy - the urease test for Helicobacter pylori detection was positive and specific treatment was administered. In addition, a psychiatric evaluation was done because of behaviour changes. Aerophagia was suspected, and clonazepam treatment was recommended. Conclusion. This is an unreported case of association between Helicobacter pylori infection and aerophagia, which had a favourable outcome after antibiotherapy for gastritis and clonazepam for psychologic aerophagia.