Objective: To report a case of varicella complicated by acute osteomyelitis in order to remind of a rare and potentially serious complication of a very common pediatric disease.Case description: A previously healthy 3-month-old female infant with 10-day history of varicella was admitted to the hospital for fever, groan and prostration. The initial laboratorial evaluation was compatible with bacterial sepsis. By the third day after admission, a swelling of the seventh left rib had developed. The ultrasound and scintigraphy evaluation suggested rib osteomyelitis. Blood cultures were negative. The patient completed six weeks of antibiotics with favorable clinical, laboratorial and imaging evolution.Comments: Varicella is one of the most frequent exanthematic diseases of childhood and it is usually self-limited. The most frequent complication is bacterial infection of cutaneous lesions. Osteoarticular complications are rare, and rib osteomyelitis is described in less than 1% of cases. The main route of dissemination is hematogenic, and the most frequent etiological agent is Staphylococcus aureus. The prognosis is generally good and depends on early detection and antibiotic initiation.

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Introduction: Complex chronic conditions are becoming more prevalent in paediatric age, as a group of diseases requiring a multiplicity of care and technological resources and with a great impact on children, family, and society. Palliative care has a growing significance in its approach.Methods: Observational, longitudinal, and retrospective analysis of hospital admissions due to complex chronic conditions in the Paediatric Ward of a level II hospital over a five-year-period (2015)(2016)(2017)(2018)(2019). Results:We had 431 hospitalizations (209 patients), corresponding to 18% of total hospital admissions in the period studied. Median length of stay was 5 days. Male sex counted for 59% of all hospitalizations and median age was 5 years. The most frequent categories were neurologic and neuromuscular disorders (39%) and hematologic disorders (23%); the main diagnosis were sickle cell disease (23%) and cerebral palsy (16%). We verified pluripathology in 15% and polymedication in 32%. The most associated comorbidities were epilepsy (29%) and sleep disorders (18%). Dependency on technological support was found in 26%. The decompensation of the underlying disease was the main reason for hospitalization (52%); 4 hospitalizations were aimed to caregiver's rest. 14% of patients had ambulatory's specific support. Death occurred in 4 patients. Conclusion:This study, innovative at national level, revealed a significant rate of hospital admissions due to complex chronic conditions. Awareness of this reality is essential for planning a suitable healthcare system based on a multidisciplinary approach. It is crucial to encourage our national Paediatric Palliative Care network and enhance education and social security support.