Abraitytė, Simona

Introduction Mycoplasma pneumoniae is a common respiratory pathogen and a frequent cause of community-acquired pneumonia. Rarely, this bacterium can cause extrapulmonary manifestations, including mucocutaneous involvement. [1] We report a clinical case of M. pneumoniae infection causing recurrent rashes resembling lupus erythematosus and erythema infectiosum, highlighting the need to consider this pathogen in unexplained cutaneous eruptions. Case Presentation An 8-year-old girl developed eye irritation followed by a red, symmetrical rash spreading from her face to the limbs over several days. Recurrent erythematous plaques appeared weekly, each episode lasting three days. Antihistamine therapy was ineffective. No systemic symptoms or fever were observed, the mucous membranes remained unaffected. Cutaneous lupus erythematosus and parvovirus B19 infection were considered in the differential diagnosis, but subsequent laboratory investigations were negative. A complete blood count showed no significant abnormalities, however, extended laboratory testing revealed positive M. pneumoniae IgM antibodies. Antibacterial therapy with clarithromycin was initiated. Longterm follow-up was unavailable, as the patient did not return due to clinical improvement. Discussion About 25% of M. pneumoniae infections manifest with cutaneous eruptions. [2] The factors determining the presentation and severity of M. pneumoniae-related cutaneous disease remain unclear. The condition is considered immune-mediated, with immune complex formation causing tissue injury. [3] These clinical cases are highly variable, ranging from nonspecific rash to toxic epidermal necrolysis. Despite the different manifestations, they may occur during active or asymptomatic infection. [4] The most common cutaneous presentation is a non-specific exanthem [2], which begins as a single macule and may spread to the face and limbs, usually resolving within 2-22 days. [4]. M. pneumoniae infection is usually treated with macrolides and cutaneous lesions can be managed symptomatically with topical emollients. [5] Conclusions An awareness of the presentations of M. pneumoniae as a cutaneous disease is essential, as they may occur at any stage of the disease and be mistaken for other conditions. A high index of suspicion is important for timely diagnosis and appropriate treatment.

Background More than 8.5% of children aged 6–7 suffer from allergic rhinitis, and it is even more common among teenagers, aged 13–14 (14%). Allergic rhinitis worsens the quality of life for children of all ages. It can cause sleep difficulties, reduce participation in daily activities, and negatively impact academic performance, physical activity, and social functioning. Studies show that sublingual immunotherapy has a positive effect on allergy symptoms and that systemic side effects are considered rare for this type of treatment.

Method A retrospective cohort study was performed using the data from the Department of Pediatrics of the Hospital of Lithuanian University of Health Sciences outpatient registry to acquire the data of patients using sublingual immunotherapy. The data of 44 patients was collected. Data was analyzed using IBM Statistics SPSS for frequencies, t and χ2 tests.

Results The mean age when starting sublingual immunotherapy was 6.89 years. 43% of patients immunotherapy duration was less than 1 year, almost 23% - more than 3 years. The most prevalent allergy risk factor was living in the city (59.1%) as shown in figure 1. More than 93% of patients had congested nose before starting immunotherapy. Sneezing and nose itching was a problem for 88.6% of children. Runny nose bothered 79% of patients. A positive effect was seen in 91%. Due to this treatment, 20.5% of patients had no longer allergy symptoms and did not need medication for them. 9% did not feel any positive effect. 90.9% of patients did not experience any side effects. However, out of those who did have them, the most common was stomach ache (6.8%) and nausea (2.3%).

Conclusion Most patients had a positive effect during the use of sublingual immunotherapy. Only a small number of patients did not feel any changes in their allergy symptoms. Furthermore, most patients did not encounter any side effects.

Objectives: A 9-year-old boy presented to the emergency de-partment with a chronic rash persisting for 3 months, alongsidea new rash that had appeared over several days. He had beenpreviously healthy with no chronic conditions. The patient en-gages in motocross and uses jumpsuits that increase sweating.The patient's mother reports frequent scratching due to this con-dition. Upon examination, the patient exhibited elevated, dry,crusty, itchy lesions on the right elbow, left arm, and both shins.Additionally, small, skin colored papular rashes were noted onthe knees and elbows. Despite treatment with oral and topicalantibiotics, permethrin, systemic antibiotics, corticosteroids,oral antihistamines, and topical glucocorticoids, no significantimprovement was observed. The patient was subsequently hos-pitalized for intravenous antibiotic therapy and glucocorticoids,resulting in resolution of both types of rashes during hospital-ization. However, a few days later, the patient returned to theoutpatient clinic with a new rash on his right arm. The rash wasalso itchy, elevated, erythematous.Method:Results: A skin biopsy was performed on the new erythema-tous, elevated lesion on the right arm, revealing dermal fibrosisand lymphocytic infiltration, suggestive of an process.Discussion: The clinical findings are consistent with nummu-lar eczema, which may have led to intense itching and subse-quent keloid formation. The other rash regressed spontaneously,which may help differentiate it from phrynoderma or coxsackieviral infection.This case illustrates the diagnostic challenges in pediatric der-matology and allergology, emphasizing the importance of thor-ough evaluation and consideration of underlying conditions thatmay exacerbate chronic skin issues, as well as the need for ongo-ing monitoring and tailored treatment strategies.

Objectives: A 15-year-old girl presented to the emergency department with a progressive, painful, non-pruritic, scaly, erythematous rash with plaques, predominantly on her chest. Rash appeared 2 weeks ago and started to progress actively 2 days ago. Yellowish flakes were observed on the scalp and on the ears. On the extremities and inguinal region, individual pustular rash elements were noted. Over time, yellowish pustules developed on the arms. Patient had no other systemic symptoms and co-morbidities. A few weeks prior, had experienced a sore throat. Recently, the patient has been under increased stress due to exams and has been suffering from insomnia. Results:• Complete Blood Count: WBC: increased from 9.9 to 16.2× 10 9 ; Neutrophils increased from 6.8 to 12.4 × 10 9.• CRP: Increased from 5 to 7.2 mg/L.• Skin Punch Biopsy: Hyperparakeratosis, psoriasiform features, intracorneal focal neutrophils, moderate peri-vascular lymphocytic infiltration. No fungal changes observed.• Microbiological Tests: S. aureus in cultures from the nose, ears, and superficial wounds.• ANA Test: Negative.• Mantoux Test: Negative.• Diagnosis: Generalized pustular psoriasis. Discussion: Generalized pustular psoriasis (GPP) is a rare, neutrophilic auto skin disease characterized by sudden episodes of widespread rash and sterile pustules. Most common form of psoriasis in children is guttate (plaque) psoriasis. This case highlights the importance of early recognition and diagnosis of GPP in pediatric patients, as it requires targeted treatment strategies such as systemic retinoids (e.g., acitretin).Also, it emphasizes the unique presentation of GPP in a pediatric patient and underscores the need for multidisciplinary care to optimize diagnosis and treatment outcomes.

Urticaria in pediatric patients is a condition with varied etiologies, presentations, and responses to treatment. This case series illustrates the diversity in urticaria phenotypes, causes, and clinical outcomes among three pediatric patients.

Case Presentations:Three boys aged 6, 10, and 14 years presented with hives. They had different durations and responses to prescribed treatment.

Discussion:This case series highlights the range of urticaria phenotypes in pediatric patients, from acute infection-related urticaria in younger patients to chronic, treatment-resistant urticaria in older patients with possible cholinergic, heat, stress or other triggers. While younger patients' urticaria resolved with infection treatment and antihistamines, the adolescent's chronic form was resistant to standard therapies, likely due to an idiopathic and cholinergic component.

Conclusion:These pediatric clinical cases of urticaria illustrate the diverse presentations and underlying causes of the condition. Specialist consultation is recommended when symptoms persist for several weeks or fail to improve under the care of a general practitioner or general pediatrician. Effective management necessitates a tailored approach, as evidenced by the varied outcomes observed in these cases.

Introduction Atopic dermatitis is a chronic, recurrent inflammatory skin condition [1]. The patch test is the gold standard used to identify type IV hypersensitivity reactions, with sensitivity and specificity ranging from 70% to 80% that can help identify food allergies in children with atopic dermatitis who do not have elevated serum IgE levels [2, 3]. Aim To use skin patch test as a way to determine which food products are most commonly associated with delayed allergic reactions, evaluate the relationship between these reactions and the child's age and assess the frequency of delayed allergic reactions in children with atopic dermatitis. Methods From 2022 to 2024, a diagnostic trial using the atopy patch test was conducted at the LUHS Kaunas Clinics, Pediatric Diseases Clinic, for children who were consulted by a pediatric allergist at the LUHS Children's Outpatient Clinic due to atopic dermatitis. The study included 299 children aged 3 months to 16 years. All children underwent a patch test with 25 food allergens: 14 standard and 11 self-provided. The results were evaluated after 48 and 72 hours. Data analysis was performed using the software IBM SPSS Statistics (29.0). The study results are presented as numerical data and percentages. The relationship between nominal variables was determined using the Chi-square test. Relationships between variables were considered statistically significant if p < 0.05. The relationship between continuous variables was assessed using the Student‘s t-test. Differences between groups were considered statistically significant if p < 0.05. Results The five most frequently reactive food items overall (from 14 standard and 11 self-provided products) were: wheat (28.8%), buckwheat (26.4%), peanuts (25.4%), chicken (13.4%), and carrots (12.7%). Delayed reactions identified through patch testing were observed in 44 cases (14.7%). Almost all children with atopic dermatitis and positive skin patch test were under 4 years old, comprising 43 children (97,7%). Children with positive skin patch test result were significantly younger (21,4 months) than those with negative results (31,6 months) (t(144.4) = 3.79, p < 0.001), with a mean difference of 10,2 months (95% CI: 4.89 - 15.53). Conclusions Delayed allergic reactions can be diagnosed using skin patch test for children with atopic dermatitis. The most frequently identified food allergens for children were wheat, buckwheat, peanuts, chicken and carrots. Patch test results were more frequently positive in children under 4 years old, suggesting that patch testing is more informative when conducted in younger children.

Dilgėlinė yra viena iš dažniausiai vaikams pasitaikančių odos būklių ir viena labiausiai paplitusių alerginių ligų pasaulyje. manoma, kad bent kartą gyvenime dilgėline suserga kas penktas žmogus, įskaitant ir vaikus. Vaikų populiacijoje dilgėlinė skiriasi pobūdžiu, trukme, priežastimis ir neretai net klinikine išraiška, palyginti su suaugusiais asmenimis. Šiame straipsnyje apžvelgsime vaikams pasireiškiančios dilgėlinės fenotipus ir dažniausias jos priežastis.

Atopinis dermatitas - lėtinė, atsinaujinanti uždegiminė odos liga, priskiriama IgE ir ne IgE sukeliamų ligų grupei. Vienas iš diagnostinių metodų - odos lopo mėginys (OLM), kuris yra neinvazinis tyrimas, padedantis įtarti lėtojo tipo įsijautrinimą maisto produktams atopiniu dermatitu sergantiems vaikams, kai kraujo serume nenustatoma padidėjusi IgE koncentracija. 2022-2024 m. LSMUL Kauno klinikų Vaikų ligų klinikoje buvo atliktas odos lopo mėginio su maisto alergenais tyrimas vaikams, kurie dėl atopinio dermatito buvo ambulatoriškai konsultuoti vaikų alergologo LSMUL KK Vaikų konsultacinėje poliklinikoje. Iš viso buvo ištirti 299 vaikai nuo 3 mėn. iki 16 metų amžiaus. Šio tyrimo rezultatai buvo palyginti su 2015 m. toje pačioje klinikoje atliktu panašiu tyrimu. Gauti rezultatai: atopiniu dermatitu sergantiems vaikams, atliekant odos lopo mėginius su 14 standartinių ir 11 atsineštų maisto produktų, dažniausiai rasti šie 5 maisto alergenai: kviečiai, grikiai, žemės riešutai, vištiena ir morka. Tyrimo duomenys buvo lyginami su moksliniame žurnale „Vaikų pulmonologija ir alergologija" 2015 m. publikuotu straipsniu, kuriame analizuoti panašūs vaikams atliktų OLM rezultatai. Abiejų tyrimų, kuriuose vertintas OLM su maisto alergenais, duomenimis, dažniausias maisto alergenas tarp atopiniu dermatitu sergančių vaikų išlieka kviečiai. Šis tyrimas patvirtina, kad lėtosios (uždelsto tipo) alerginės reakcijos yra gana dažnos atopiniu dermatitu sergantiems vaikams, todėl odos lopo mėginys su maisto alergenais yra informatyvi ir perspektyvi diagnostinė priemonė lėtosioms alerginėms reakcijoms nustatyti.

Background: Carbohydrate Cross-Reactive Determinants (CCDs) are protein-bound carbohydrate structures that are responsible for part of the phenomenon of cross-reactivity. They play a major role in allergy diagnosis. They are responsible for cross-reactions between completely different allergen sources.Aim: To compare the specific IgE test results in our patients with and without anti-CCD absorbents.Method: The retrospective study included 74 patients with suspected allergic rhinitis and other atopic diseases – (74% (n55) were children, 74% (n55) were men) in whom specific IgE was tested sero-logically in vitro based on reactivity to the CCD marker and repetition of specific IgE with the CCD absorbent.Results: The most common inhaled allergens were house dust mites,grasses and spring trees. Statistically significant (p > 0.05) decrease in inhaled allergen spec. IgE results after inhibition with CCD absorbent (diagram 1). Most food allergens decreased or completely disappeared after inhibition with CCD absorbent (diagram 2). Seafood,lamb, egg white, soybean and pet allergens specific IgE results in-creased after inhibition with CCD absorbent (diagram 3). Significant research results when comparing age groups and genders: boys up to 18 years were statistically significantly more frequently sensitized toplantain (lot. Plantago major) than girls t = 2.33, df = 32, p = 0.026, and adult males were statistically significantly more frequently sensitized to D. farinae (house dust mites) than females t = 3.14, df = 5, p = 0.025.Conclusion: The CCD absorbent is very important when testing specific IgE to allergens: 1) Without cross- reactive allergens and similar to CCD absorbents, proteins that indicate more specific allergies. 2)Food (f.e. crabs) and pet allergens show an inverse result with the CCD absorbent – this can be explained by the fact that the concentration of bingind proteins decreases after inhibition. The CCD absorbent increases the diagnostic specificity.DIAGRAM 1 The most common inhalatnt allergens (specific IgE)before and after inhibition with CCD absorbent.

Introduction: Previously healthy 8-year-old boy presented to the emergency department with a itchy maculopapular rash which later developed into target lesions with progression predominantly in his face, limbs, palms and soles. Right leg was swollen. No rashes on the mouth and genitals. Patient had febrile fever for a few days every 12 hours. One week before he played golf on the artificial grass, probably he had an unknown sting bite on his right shin a day before the rash as well. He had no allergies up to now, no history of chronic diseases. Methods: –. Results: Lab. tests: CRP 28 - > 5 mg/L, (slightly elevated, then normal), blood count – eosinophilia (abs. count 3,7 x 10^9/l), ASO titer 559kU/l—(elevated), strep test—positive, Respiratory Viral Panel (DNA)—Parainfluenza A virus, Parainfluenza B virus, Metapneumovirus,Adenovirus, Coronavirus HKU-1, Rhinovirus, Bocavirus, Parainfluenza 1 virus, Parainfluenza 2 virus, Parainfluenza 3 virus, Parainfluenza 4 virus, Respiratory syncytial virus A/B, Coronavirus NL63, Coronavirus 229E, Coronavirus OC43, Enterovirus—notfound. Liver enzymes, electrolites levels without changes, HSVIgM, IgG—negative, CMV IgM, IgG – negative, EBV IgG, IgM negative, Imunoglobuline E—625 kU/l—elevated. Blood, urine and tonsills swab test—negative, SARS CoV-2 infection antibodies—notfound. Radiologic tests: Ultrasound of left knee—oedemous soft tissues, small streak of liquid. Ultrasound of heart—without changes.Ultrasound of internal organs—without changes.Diagnosis: Idiopathic erythema multiforme minor.Discussion. Erythema multiforme (EM) first described in literature in 1886. It is uncommon inflammatory skin disease which has a pathognomonic sign—target lesion, sometimes oral or other mucosal involvement. This disease affects all age groups, 20% patients are kids,males are a bit more common than females. Etiology—in most cases are unknown, also can be caused by viruses (HSV1, HSV2, CMV,etc.), atypical infections (Mycoplasma pneumonia, Streptococcus,etc.), medications. There are a few cases that EM was caused by a spider-bite. Conclusions: In this case the cause is unknown, but the main triggers could be – Streptococcal infection (Elevated ASO titer, positive Strep test), insect bite or some allergens due to artificial grass. Table of classification of erythema multiforme. [...].