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

Cystic echinococcosis (CE) is among the most common zoonotic infections worldwide. Studies about CE are limited in childhood. The aim of this study was to evaluate clinical, radiological and laboratory characteristics of childhood CE at a tertiary care pediatric hospital. Medical records of children with CE were analyzed between January 2005 and January 2015. A total of 130 patients with a median age of 10.4 years (IQR= 7.2-years-13.2 years) were evaluated. The anatomic locations of cysts were as follows; liver (76.9%), lung (36.9%), spleen (6.2%), pelvic region (3.8%) and kidney (2.3%). The most common symptoms were abdominal pain and cough in the patients with liver cysts and lung cysts, respectively. The indirect hemagglutination (IHA) test positivity was 58%. Elevated serum total immunoglobulin E levels were detected in 59% of the patients. Fourty-four patients with liver CE, 33 patients with lung CE were treated surgically and 23 patients with liver CE were treated with percutaneous aspiration, injection and re-aspiration (PAIR) along with medical treatment. The recurrence was observed in five patients with liver CE. It was demonstrated that CE mainly involves liver but lung cysts are more frequently symptomatic and prone to be complicated than liver cysts in children. IHA test positivity together with abdominal ultrasonography are useful to diagnose liver CE but thorax CT is usually needed to diagnose lung CE. Liver cysts that are sized greater than 5 cm are more frequently treated with PAIR or surgery but smaller liver cysts can be treated medically.

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.

Background. The prevalence of community-acquired methicillin-resistant S. aureus (CA-MRSA) has been increasing worldwide. We aimed to investigate the prevalence of MRSA in community-acquired S. aureus infections, the risk factors for CA-MRSA infection and the clinical features of CA-MRSA. Methods. A multi-center study with prospective and retrospective sections was conducted. Patients ≥ 3 months old and ≤18 years of age who were diagnosed with community-acquired S. aureus infections were included in this study and the patients` information were reviewed from the medical and microbiological database of the hospital. A standard question form about living conditions and exposure risk factors was administered to the parents of patients. The CA-MRSA infections were compared with the methicillin-susceptible S. aureus (CAMSSA) infections in terms of the queried risk factors and clinical variables. Results. We identified 334 pediatric patients with S. aureus infection, 58 (17.4%) had an infection with CAMRSA. The refugee rate was higher in the CA-MRSA group. There was no significant difference regarding the exposure risk. The treatment modalities and outcomes were similar. Conclusions. The study was not able to show reliable clinical variables or epidemiological risk factors except for being a refugee for CA-MRSA infections. Empirical antibiotic treatment should therefore be determined according to the local CA-MRSA prevalence in patients presenting with a possible staphylococcus infection.