Medical treatment is rarely recommended. The aim of our study is to evaluate follow-up and response to medical treatment in patients affected by hydatid cystis (HC). Methods We conducted a retrospective study about all cases of HC treated by albendazole in paediatrics department of Hedi Chaker University Hospital in Sfax over a period of 10 years (2004-2013). Results We report 6 cases of HC treated medically. Ages ranged between 2 and 8 years. Diagnosis was based on laboratory and imaging studies. Hydatid cystis had multiple localizations in all of cases: multiple hepatic HC (1 case), bilateral pulmonary HC (1 case), hepatic and pulmonary HC (1 case), hepatic and splenic HC, hepatic, splenic and renal HC and hepatic, pulmonary, cardiac and pancreatic HC. All patients were treated with Albendazole (10 mg/kg/day during 6 to 24 months). Surgical treatment was associated in 4 cases. The outcome was favourable in all cases. Conclusions Surgery remains the ideal treatment for hydatid cysts. However, medical treatment with albendazole can be efficient and can, in some circumstances, replace surgery especially in case of multiple locations.

BackgroundAutoimmune hemolytic anemia is rare in children. First-line therapies for this disease consist of corticosteroids and intravenously administered immunoglobulin that are effective in most patients. However, a small proportion of cases (5 to 10%) is refractory to these therapies and may represent a medical emergency, especially when hemolysis is due to warm immunoglobulin M. Recently, reports of the use of rituximab in adult autoimmune diseases have shown promising results. In children, there are few studies on the use of rituximab in the treatment for autoimmune hemolytic anemia, especially on its long-term efficacy and adverse effects.Case presentationHere, we report the case of a 10-year-old Tunisian girl with refractory acute autoimmune hemolytic anemia caused by warm-reactive immunoglobulin A, immunoglobulin G, immunoglobulin M, and C3d autoantibodies. First-line treatments using corticosteroids and intravenously administered immunoglobulin were ineffective in controlling her severe disease. On the other hand, she was successfully treated with rituximab. In fact, her hemolytic anemia improved rapidly and no adverse effects were observed.ConclusionsThe case that we report in this paper shows that rituximab could be an alternative therapeutic option in severe acute autoimmune hemolytic anemia with profound hemolysis refractory to conventional treatment. Moreover, it may preclude the use of plasmapheresis in such an urgent situation with a sustained remission.

Background Children affected by Coronavirus disease 2019 (COVID-19) showed various manifestations. Some of them were severe cases presenting with multi-system inflammatory syndrome (MIS-C) causing multiple organ dysfunction. Case presentation We report the case of a 12-year-old girl with recent COVID-19 infection who presented with persistent fever, abdominal pain and other symptoms that meet the definition of MIS-C. She had lymphopenia and a high level of inflammatory markers. She was admitted to pediatric intensive care unit since she rapidly developed refractory catecholamine-resistant shock with multiple organ failure. Echocardiography showed a small pericardial effusion with a normal ejection fraction (Ejection Fraction = 60%) and no valvular or coronary lesions. The child showed no signs of improvement even after receiving intravenous immunoglobulin, fresh frozen plasma, high doses of Vasopressors and corticosteroid. His outcome was fatal. Conclusion Pediatric patients affected by the new COVID-19 related syndrome may show severe life-threatening conditions similar to Kawasaki disease shock syndrome. Hypotension in these patients results from heart failure and the decreased cardiac output. We report a new severe clinical feature of SARS-CoV-2 infection in children in whom hypotension was the result of refractory vasoplegia.

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