Background:Recurrent fever syndrome, known as the Marshall syndrome (MS), is a clinical entity that includes several clinical features, such as: fever (39–40°C) that occurs repeatedly at variable intervals (3–8 weeks) and in episodes of 3 to 6 days, cervical adenopathy, pharyngitis, and aphthous stomatitis. The diagnosis of MS is one of exclusions; laboratory data is nonspecific and no abnormalities correlated with MS have been detected thus far.Methods:The authors report the case of a 2-year-old girl admitted to a tertiary pediatric center for repeated episodes of fever with aphthous stomatitis and laterocervical adenopathy.Results:The child's case history raised the suspicion of MS, which was subsequently confirmed by exclusion of all the other differential diagnoses (recurrent tonsillitis, juvenile idiopathic arthritis, Behçet's disease, cyclic neutropenia, hyperglobulinemia D syndrome). After the 3 febrile episodes, bilateral tonsillectomy was performed based on the parents’ consent, with favorable immediate and remote postoperative clinical outcomes. The diagnosis of MS is one based on exclusion, as laboratory data is nonspecific. We took into consideration other causes of recurrent fever (recurrent tonsillitis, infectious diseases, juvenile idiopathic arthritis, Behçet's disease, cyclic neutropenia, Familial Mediterranean fever syndrome, hyperglobulinemia D syndrome). In our case, MS criteria were met through clinical examination and the child's outcome. Subsequently, laboratory data helped us establish the MS diagnosis.Conclusions:Pediatricians should consider the MS diagnosis in the context of recurrent fever episodes associated with at least one of the following symptoms: pharyngitis, cervical adenopathy or aphthous stomatitis. Despite the indication for tonsillectomy in young children being controversial, in this case the surgery led to the total remission of the disease.

Ulcerative colitis (UC) is a chronic inflammatory disease of non-infectious and plurifactorial etiology, exclusively affecting the colon, with variable expansion. The selective deficiency of immunoglobulin A (IgA) can be frequently associated with UC, as well as with recurrent respiratory tract infections, autoimmune diseases, atopy. The incidence of vitiligo among UC patients is significantly higher compared to the general population. At the same time, recent studies proved a higher incidence of Clostridium difficile infections in patients with inflammatory bowel disease (Crohn's disease and ulcerative colitis) compared to the general population. We are presenting the case of a 9 year old girl, where UC associated with selective deficiency of IgA and vitiligo hampered the diagnosis and therapeutic approach, particularly in the conditions of a preexisting Clostridium difficile infection. The association of these entities is rare in the pediatric population and a multidisciplinary team approach (gastroenterology, dermatology and immunology) can ensure an effective therapeutic management in the case of such patients.

Sarcinile nedorite reprezintă o problemă serioasă a morbidităţii în anii adolescenţei, utilizarea contraceptivelor fiind un element de prevenţie la această vârstă. Adolescentele obeze tind să folosească mai puţin metode contraceptive decât cele cu o greutate normală, excesul de greutate fiind des folosit ca motiv pentru neutilizarea metodelor contraceptive. Acestea au o probabilitate crescută de a avea sarcini nedorite asociate cu toate riscurile gravidităţii şi naşterii la o vârstă fragedă, având totodată nevoie de metode mai sigure şi eficiente de contracepţie. Scăderea numărului de sarcini la această categorie este o prioritate a sănătăţii publice şi impune detectarea adolescentelor aflate în categoria de risc. Deşi există opinii împotriva contracepţiei din cauza efectelor adverse, Organizaţia Mondială a Sănătăţii promovează ideea că adolescenţii pot utiliza orice metodă de contracepţie datorită avantajului de a preveni sarcinile nedorite, care depăşeşte riscurile utilizării lor.

Acute acalculous cholecystitis associated with Epstein Barr virus (EBV) infection is a known entity, as opposed to the extremely rare cases of cystic duct stenosis secondary to EBV-related inflammation. The authors present the case of a 10-year-old male patient admitted with altered general state, anorexia, painful and distended abdomen. The patient had a history of EBV acute hepatitis two years prior to the current presentation, diagnosed based on clinical examination (fever, vomiting, and severe pain of right upper abdominal quadrant), and abdominal ultrasound revealing acute acalculous cholecystitis with gallbladder hydrops; still no indication for surgical treatment was made. The clinical outcome was favorable, but during those two years he suffered two episodes of chronic acalculous cholecystitis exacerbation, which required a MRI examination, indicating gallbladder hydrops and narrowing of terminal segment of the cystic duct (secondary inflammatory processes). The biological investigations revealed cholestasis, hepatocytolysis and inflammatory syndrome and the abdominal-ultrasound indicates an acalculous gallbladder and gallbladder hydrops. After cholecystectomy, the histopathological examination revealed chronic inflammation of the gallbladder wall, setting the diagnosis of exacerbation of chronic acalculous cholecystitis. Particularly for the case is the development of cystic duct stenosis, after the EBV acute infection. The clinical and laboratory outcome (monitored after 1, 3, 6, and 12 months) was favorable.

In this article we report the case of a 46 year-old male presenting with pulmonary, sinusal, otic, nasal and laryngeal lesions. He was diagnosed in December 2013 with granulomatosis with polyangiitis and we tried to achieve remission with cyclophosphamide and glucocorticoids. The onset of the disease included pansinusitis accompanied with mastoiditis and paralysis of the left facial nerve, bilateral hearing loss and episodes of intense headache. The patient underwent two surgeries to solve the Ear-Nose-Throat (ENT) area symptoms which have delayed the diagnosis and the initiation of appropriate therapy.