Clinical data on coronavirus disease-19 (COVID-19) in children during the management of nephrotic syndrome (NS) is lacking. Patients on prednisolone are compromised hosts at the risk of severe infections. Some infections may induce NS relapse. We describe the clinical course of a child with NS and COVID-19. A 3-year-old boy was admitted with clinical and laboratory findings indicative of NS. Induction therapy with prednisolone (2 mg/kg/day) induced complete remission. While tapering the dose, he was infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). He developed a high fever and periorbital edema. Urinalysis revealed proteinuria (protein-creatinine ratio: 6.3 g/gCr). He was transferred to our hospital for the concurrent management of COVID-19 and NS relapse. As proteinuria worsened, the prednisolone dose was increased to 2 mg/kg/day. Proteinuria gradually improved, and remission was noted a week after initiating full-dose steroid treatment. The fever subsided after 2 days without treatment for COVID-19. Anti-SARS-CoV-2 antibody including IgG levels decreased in the early convalescent phase. To the best of our knowledge, this is the first reported case with the recurrence of NS triggered by the SARS-CoV-2 infection in Asia. SARS-CoV-2 infection may induce NS relapse. Daily administration of full-dose of prednisolone may be effective for managing the recurrence of NS associated with SARS-CoV-2 infection.

No abstract

Background Kimura’s disease (KD) is a rare chronic inflammatory disease of unknown etiology. Clinically, KD is characterized by nodular subcutaneous masses, that are typically localized to the neck and head. Involvement of the lacrimal glands and limbs is uncommon and seldom reported. Case presentation We report a case of a 4-year-old Japanese boy presenting with bilateral upper eyelid swelling with nodular subcutaneous lesions and peripheral eosinophilia. Based on clinical, histopathological, and laboratory findings, the patient was diagnosed with KD. An itchy subcutaneous mass on the left arm developed at the age of 14 years. Treatment with steroids was effective. However, as the steroids were tapered after the patient developed side effects, the masses relapsed within a few months. Treatment with cyclosporine A was then initiated, which led to an improvement of clinical features and serial levels of cytokines. Conclusions We report a rare case of KD with a peculiar clinical presentation. The patient responded well to treatment with cyclosporine A.

Atypical hemolytic uremic syndrome (aHUS) is characterized by thrombotic microangiopathy secondary to uncontrolled activation of the complement system. Extra-renal manifestations of aHUS affect the prognosis of this condition; therefore, optimal management of extra-renal manifestations of aHUS is important. A 3-year-old girl admitted with hematuria, proteinuria, and generalized edema was diagnosed with aHUS. We report a pediatric case of life-threatening extra-renal manifestations of aHUS, including gastrointestinal bleeding, refractory hypertension, pulmonary edema, and reversible cerebral atrophy in a patient who was successfully treated with multidisciplinary treatment. In addition to plasma exchange and eculizumab combination therapy, we administered renin-angiotensin system inhibitors for refractory hypertension and octreotide acetate for body fluid management in ischemic enteritis. Notably, multi-organ involvement in patients with extra-renal manifestations of aHUS can result in serious complications in the absence of appropriate treatment; therefore, systemic management with multidisciplinary treatment is important for improved prognosis.

No abstract