Kawasaki disease (KD) is an acute febrile vasculitis of an unknown cause. It affects children <5 year of age, even if cases over 5 years old have been also reported. It is the commonest cause of acquired heart diseases in children which may lead to serious morbidity and mortality. The complications and mortality increase when the diagnosis is delayed. One of the main reasons leading to delayed diagnosis and consequent delayed treatment is the unusual presentation of KD. Its unusual manifestations have been increasingly reported to jeopardize the timely diagnosis and proper treatment. As there is not yet available blood test to diagnose it, low threshold should be taken into account for considering KD, when the clinical criteria are not typical. KD with renal manifestations is infrequently described. We present and discuss a case of an unusual presentation of KD presenting as bloody diarrhea and acute renal failure.

The most common causes of umbilical discharge in infancy are infection and umbilical granuloma that may be treated by antibiotics and topical application of silver nitrate subsequently. If the umbilical discharge persists or if there is any abnormal discoloration around the umbilicus, it is important to investigate for underlying congenital abnormality that may be cured by surgical intervention. Unusual presentation of omphalomesenteric duct cyst has been reported in literature. We report, for the first time as far as our search is concerned, a case of a 16-month-old infant who presented initially with persistent umbilical discharge and finally with bruising around the umbilicus in keeping with Cullen’s sign. A diagnosis of omphalomesenteric duct cyst containing pancreatic tissue was made on histopathological examination. This case emphasizes that, a persistent umbilical discharge and or discoloration around the umbilicus should be further investigated and an omphalomesenteric duct cyst can present as Cullen’s sign.

Onychomadesis or onycholysis is a newly recognized complication in the course of viral infections particularly the Hand Foot Mouth Disease (HFMD) in children and adults. Onychomadesis is characterized by proximal separation of the nail plate from the nail matrix due to temporary cessation of growth of the nail matrix. The etiology of onychomadesis is including infections, trauma, medications side effects, systemic diseases and idiopathic. The association of the HFMD and the onychomadesis first reported in the year 2000. Since then, few studies and case reports published illustrating the relationship of the HFMD and the resultant onychomadesis 4 to 8 weeks after the resolution of the HFMD. HFMD is a relatively common viral infection, especially in children of preschool age. It is usually presented with characteristic eruption on hands, feet and mouth. Out breaks may happen in nurseries and schools. HFMD usually caused by enteroviruses, most commonly, Coxsackie virus A (CVA) and enterovirus 71 (EV71). It is usually self-limiting disease however; serious neurological complications have been reported with EV71. The enteroviruses that cause HFMD and nail changes may cause herpangina which is unlike the HFMD, usually characterized by mouth spots on the soft palate without the skin manifestations, however onychomadesis was not reported before with herpangina. This case presented with no HFMD eruption but small red spots on the soft palate consistent with herpangina. Enterovirus was isolated from throat swab and the onychomadesis occurred 1 month after the resolution of the soft palate spots. It is the first case report about nail changes occurring after herpangina presentation. It is therefore important that in patients presented with onychomadesis to consider the review of the patient's history not only for HFMD but herpangina and possible other EV infections, 8 weeks before the nail changes, to avoid unnecessary referrals, concerns and over investigations. The exact mechanism of the nail changes is not yet known and a review of theories behind the nail damage will be considered in this report.

Children are developing individuals with countless factors affecting their growth and development, from genetics to parenting, schools, environments, nutrition, good habits of sleep and health. They are very sensitive individuals to sudden changes in routine. Schools represent life for them and a place of not only learning, but also social interaction and sensory neurodevelopment. Disasters and pandemics such as the existing situation of COVID-19 are a major cause of trauma affecting their education, play, mental health, physical health, vaccinations, sleep, and development. The governments' strategies particularly home confinement and school closure to prevent the COVID-19 pandemic spread added unavoidable stress and psychosocial impacts on both adults and children. Trauma of this kind may endure for a long time with negative consequences that may manifest later on, even up to adult life. We conducted a cross sectional parental survey, to assess the impacts of home confinement on children in the cosmopolitan city of Dubai, UAE. Children included were from 3 years until 16 years old who were in schools or pre-school placements before COVID-19 started. Total number of children included in the survey was 658 of which 327 were boys and 331 girls. We found that the impact of the home confinement on children was significant and directly affected their quality of life (QoL) that may extend beyond the lockdown for longtime. This study will help relevant authorities and organizations to understand the negative impacts brought by the COVID-19 confinement on children and to adopt appropriate strategies to help children and their parents tackle these impacts and get them back to normal life and school again. This study also paved the way for future studies in the identification and management of children's behavior, attention, education, and other factors that play active roles in QoL and normal development. Moreover, this study may help in embracing early preventative and management plans by schools and authorities in future similar pandemics, infections, disasters or school outbreaks. We also discuss strategies for school reopening and flexibility when an outbreak happens again in a school or community.

Causes of facial rashes and erythema in infants are many but rarely only happen during feeding times which are commonly and sometimes wrongly attributed to food allergy. There is a rare condition called Auriculotemporal nerve syndrome that is characterized by recurrent episodes of gustatory facial flushing and sweating along the cutaneous distribution of Auriculotemporal nerve: the so-called Frey syndrome. This condition is most frequently observed in adults usually after parotid surgery. It is rare in children and is mostly attributed to forceps assisted delivery. It can also be misinterpreted as food allergy. Here we report a case of an infant with Frey syndrome without any history of perinatal trauma, which was considered initially as food allergy and highlights the importance of distinguishing it from food allergy.