The aim of the study was to identify the relationship of acquired neutropenia with childhood infections and to assess its clinical course, complications, and outcome. Children admitted to two pediatric wards over a 4-year period with febrile neutropenia were prospectively investigated for underlying infections with inflammatory markers, cultures of body fluids, and serological tests. The study included 161 previously healthy children with febrile neutropenia/leukopenia aged (mean ± SD) 3.02 ± 3.86 years (range, 0.1-14). One hundred and thirty-six out of 161 patients (84.5 %) had transient neutropenia (TN), while in 25 patients, neutropenia was chronic (CN) and persisted for ≥180 days. An infectious agent was isolated in 98/161 (60.9 %) cases, in 68.4 % patients with TN, and in 20 % of those with CN (p = 0.001). Among the patients with CN, seven had positive antineutrophil antibodies (autoimmune neutropenia) and four were eventually diagnosed with hematological malignancy. In all age groups, TN was of short duration (<1 month), of mild to moderate severity, and was predominantly associated with viral infections. Two years after diagnosis, 143/161 children (88.8 %) were available for follow-up. One hundred and thirty-seven of 143 (95.8 %) had recovered completely, while the rest remained neutropenic. The latter patients had a benign course despite severe neutropenia. In conclusion, febrile neutropenia during childhood is usually transient, often following viral and common bacterial infections, without serious complications and in the majority of cases it resolves spontaneously. However, in a considerable percentage of patients, neutropenia is discovered incidentally during the course of an infection on the ground of an underlying hematological disease.

Childhood febrile cytopenia is usually transient, of mild-to-moderate severity, and resolves spontaneously, but patients with severe cytopenia affecting ≥2 cell lines need further evaluation and follow-up.

In endemic countries, leishmaniasis is the main cause of febrile pancytopenia among children in whom hematologic malignancy has been ruled out.

decreased oral intake. The child was referred to a tertiary centre for review. On physical examination the child was alert but lethargic with tachycardia to 164 and a fever of 38.9 degrees. She had no drooling, increased work of breathing or stridor. Auscultation revealed equal air entry, normal heart and bowel sounds. Abdomen was soft, non tender without distension. She was treated with antipyretics and chest and abdominal imaging was arranged.AP chest radiograph and plain abdominal images revealed a circular 2 cm radiopaque object located in the stomach. On review by radiology the object appeared to have a 'halo sign', a feature consistent with button batteries. Given the uncertain origin of the object and potential for complications associated with button battery ingestion our patient was fasted for an endoscopy.Endoscopy revealed two 10 cent coins sitting in the gastric antrum with localized erosions and erythema. These were successfully removed with a Roth net and the patient was discharged the same day.Foreign body (FB) ingestion/inhalation most commonly occurs in children aged between six months and three years. The most common objects are coins, reported in up to 88% of cases. (1) FB ingestion usually only requires imaging followed by clinical observation. Coins are unlikely to cause complications, whereas button batteries pose a risk of metal poisoning, burns, oesophgeal strictures, perforation, tracheooesophgeal and aorto-oesophgeal fistula and haemorrhage.(2) One study revealed that 14% of children with oesophageal FBs were asymptomatic on presentation, highlighting the need for imaging. Recommended investigations include AP and lateral neck, AP and lateral chest and abdominal radiographs. (4) The sensitivity of plan films in detecting a battery was 80.4%, specificity 79.1% with an overall accuracy of 79.8%. The same study demonstrated that stacking two coins on top of each other lead to high rates of misidentification as batteries with an overall accuracy below 60%. (1) Importantly this study used artificially produced images which therefore did not include soft tissues and bony structures which could prevent accurate identification.This case highlights the importance of accurate identification of foreign objects and the need for high clinical suspicion of FB.