Objectives: The objective of this article was to present the clinical peculiarity of the Jarisch-Herxheimer reaction (JHR) during antibiotic treatment of Lyme arthritis. Material and methods: Case study presentation as a basis for discussion, literature search of PubMed database particularly in the subject of combination of the JHR and Lyme borreliosis using the combination of words "Jarisch-Herxheimer reaction" and "Lyme borreliosis", "Lyme arthritis", "antibiotic treatment", "generalized inflammation", "cytokine production", "children", "increasing awareness"; discussion of the problem based on a clinical case and cited articles. Results: The authors present a case of Lyme arthritis in a 13-year-old boy, as well as a discussion of clinical features of this complication of Lyme disease treatment as the Jarisch-Herxheimer reaction. On the 7 th day of doxycycline treatment the patient's condition deteriorated: a low-grade fever occurred, and severe arthralgias with intense hip, ankle and cervical spine pain and myalgias developed. Erythrocyte sedimentation rate and C-reactive protein were elevated. The Jarisch-Herxheimer reaction was diagnosed. This complication was characterized by severity, long duration and marked signs of inflammation. Conclusions: In the reviewed literature the Jarisch-Herxheimer reaction in patients with Lyme borreliosis is described more often in adults, with mild course and short duration of the disease. Based on the presented clinical picture this severe complication may also be associated with long duration and marked signs of inflammation. The authors suggest that informing health professionals about occurrence of the Jarisch-Herxheimer reaction should help physicians to distinguish it from allergic reactions or other conditions and improve treatment outcomes.

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Background. Trichobezoar is a dense compound in the human stomach, consisting of swallowed hair, food particles, and gastric mucus. Sometimes it passes into the initial part of the small intestine. Its clinical picture is very similar to that of a tumor, so it is necessary to conduct a thorough diagnosis. Materials and me­thods. The article deals with a case of severe protein-vitamin-iron deficiency anemia in a 5-year-old girl on the background of trichobezoar. Results. The child’s condition is severe due to the clinical picture of iron-protein-deficiency anemia of a very severe degree. During her stay in the hospital, the girl’s condition deteriorated sharply due to the rapid increase in weakness and pallor of the skin, anasarca. Due to the critical growth of the anemic syndrome, the question of the need for blood transfusion and further surgery arose. Conclusions. The peculiarity of this case is a critical increase in anemia in the absence of classic signs of hemolysis on the background of chronic eating and psychosomatic disorders. Thus, it is necessary to form vigilance in pediatricians to trichobezoar and increase the level of knowledge about the correct diagnostic algorithm in such cases.