Kawasaki disease is an acute, systemic vasculitis of unknown etiology. Although gastrointestinal involvement does not belong to the classic diagnostic criteria; diarrhea, abdominal pain, hepatic dysfunction, hydrops of gallbladder, and acute febrile cholestatic jaundice are reported in patients with Kawasaki disease. We describe here two cases presented with fever, and acute jaundice as initial features of Kawasaki disease.

Langerhans cell histiocytosis is a rare non-malignant disease with clinical heterogeneity. The disease may present with various clinical findings and may imitate many other conditions. In this report we describe a 34-monthold girl who presented with chronic otitis and otorrhea, skull fracture, rash, vulvar edema, erythema and erosion in labia majors which initially suggested child abuse but the patient was diagnosed with Langerhans cell histiocytosis.Key words: Langerhans cell histiocytosis, child abuse.Langerhans cell histiocytosis (LCH) is a myeloid cell-based neoplasm characterized by the reactive clonal increase of Langerhans cells and consisting of the components of autoimmune inflammatory disease 1 . Moreover, this disease is genetically related to BRAF-V600E gene mutation influencing the MAPK signaling pathway. Incidence rate is 8.9/million per year among children under the age of fifteen 2 . Potential symptoms encountered in LCH diagnosis in adults and children may also be observed in numerous diseases. Differential diagnosis is based on the presentation of typical histopathological findings or CD1a positive cells 3 .Tissue damage that was caused by someone else due to any reason is defined as physical abuse 4 . The awareness of conditions that simulate child abuse enables the ability to diagnose correctly. We presented a case of LCH mimicking child abuse in this report. Case ReportA 34-month-old girl was admitted to hospital with fever, rash, ear discharge and vaginal secretion. Medical history revealed crusted rash on the scalp and intertriginous areas and ear drainage from six months of age. Systemic and topical antibiotic treatments were prescribed several times with the diagnosis of acute otitis media and seborrheic dermatitis in other hospitals. At the age of one, laser polypectomy was performed through both of the external auditory canals. In addition to these complaints, vaginal secretion was observed for the last five months, and fever and rash were noted for the last five days. The patient, whose parents were third-degree relatives, had a one-year-old healthy sister.On physical examination, her general condition was moderate and she was apparently agitated. Remaining data about her physical examination were as follows; body temperature 38.1 °C, respiratory rate 24/min, pulse 101/min, arterial blood pressure 100/60 mm Hg. Apparent and locally yellowish clotted plaque was seen on the scalp, and broad erythematous skin was observed beneath it. Petechial-purpuric rashes were seen on the whole trunk and extremities. Bilateral external auditory canal was obliterated with polypoid lesion and purulent discharge. Purulent discharge, vulvar edema, erythema in labia majors, and local erosion were detected on intertriginous areas on the examination of genitourinary system. Other system examinations were normal.Routine laboratory investigations were as follows; hemoglobin (Hb) 8.9 gr/dl, white

003). Children in the empyema group had significantly more dyspnea symptoms than the children with PPE (p=0.022). Mean fever duration before hospitalization was similar in both groups. Streptococcus pneumoniae and group A streptococcus were the most common causes of empyema. All of the patients were treated with intravenous antibiotics. In addition to medical treatment, tube thoracostomy was performed in 59 of 70 (84.3%) patients in empyema group; 27 (45.8%) of them required intrapleural fibrinolysis also. In the presence of antibiotic treatment failure or in cases with moderate or large pleural effusion with loculations and clinical deterioration; it is necessary to perform drainage of the purulent fluid by tube thoracostomy, to add intrapleural fibrinolytics or to perform video-assisted thoracoscopic surgery (VATS), in order to enhance prompt recovery.

Objective: Dental caries remain one of the most common chronic diseases in childhood, globally. The purpose of this study is to determine clinical characteristics and treatment modalities of pediatric patients with odontogenic facial cellulitis. Material and Methods: Medical records of children with odontogenic facial cellulitis hospitalized in pediatric infectious disease clinic were analyzed retrospectively between January 2013 and December 2017. Results: Ninety-eight patients (43 girls, 55 boys) with median age of 86 months (min-max: 19-207 months) were evaluated. Forty-five (45.9%) patients had no regular toothbrushing habits. Forty-eight (48.9%) patients had no any dental treatment procedure history. Eighteen (18.3%) patients had never recoursed to a dentist. Seventy-five patients (76.5%) were diagnosed with odontogenic facial cellulitis for the first time. Four patients (4%) were hospitalized with the same diagnosis previously. On admission, 37 (37.8%) patients had fever. On admission, the mean white blood cell (WBC) count, erythrocyte sedimentation rate, and C-reactive protein (CRP) were 11.981 ± 4.433/mm 3 , 29.1 ± 17.6 mm/h and 35.2 ± 39.4 mg/L, respectively. The mean duration of intravenous antibiotic treatment was 5.5 ± 2.5 days, and total medical treatment was 12.5 ± 2.9 days. Ampicillin-sulbactam was started to 82 (83.7%) of the patients. Clindamycin was added to 15 (15.3%) patients. Increased mean WBC count on admission was correlated with duration of hospital stay (p= 0.036), while increased CRP level was correlated Özet Giriş: Diş çürükleri, dünya çapında en yaygın kronik hastalıklardandır. Bu çalışmanın amacı diş kaynaklı fasiyal selülit nedeniyle hastaneye yatırılan çocuk hastaların klinik özelliklerinin ve tedavi yöntemlerinin değerlendirilmesidir. Gereç ve Yöntemler: Bu çalışmada, diş kaynaklı fasiyal selülit tanısı ile Ocak 2013-Aralık 2017 tarihleri arasında çocuk enfeksiyon hastalıkları servisinde yatırılarak takip edilen hastaların diş sağlığına ilişkin öyküleri, klinik ve laboratuvar özellikleri ile tedavi şekilleri geriye dönük olarak değerlendirildi. Bulgular: Çalışmaya ortanca yaşları 86 ay (min-maks: 19-207 ay) olan 98 (43 kız, 55 erkek) hasta alındı. Hastaların 45 (%45.9)'inin düzenli diş fırçalama alışkanlığı yoktu. Kırk sekiz (%48.9) hastanın herhangi bir diş tedavisi öyküsü yoktu. On sekiz (%18.3) hasta hiç diş hekimine başvurmamıştı. Hastaların 75 (%76.5)'i ilk kez diş kaynaklı fasiyal selülit tanısı alırken, 4 (%4)'ü daha önce aynı tanıyla hastanede yatırılmıştı. Otuz yedi (%37.8) hastanın başvuruda ateşi vardı. Hastaların başvurudaki ortalama beyaz küre sayısı 11.981 ± 4.233/mm 3 , eritrosit sedimentasyon hızı 29.1 ± 17.6 mm/saat ve C-reaktif protein (CRP) değeri 35.2 ± 39.4 mg/L olarak saptandı. Ortalama intravenöz (IV) antibiyotik tedavi süresi 5.5 ± 2.5 gün, toplam antibiyotik tedavi süresi 12.5 ± 2.9 gündü. Hastaların 82 (%83.7)'sine ampisilin-sulbaktam başlanmıştı. On beş (%15.3) hastanın tedavisine klindamisin eklenmişti. Başvurudaki beyaz küre sayısı arttıkça hastanede y...