Pulmonary disease with hemorrhage in Henoch-Schöenlein purpura

Henoch-Schönlein purpura is a common vasculitic syndrome of childhood. Pulmonary hemorrhage is a rare complication, which resulted in death in three of four previously reported cases. We report concerning four additional patients with Henoch-Schönlein purpura and pulmonary hemorrhage. Three survived the episode. Aggressive and supportive care may improve survival.

"Campylobacter upsaliensis" sepsis in a boy with acquired hypogammaglobulinemia

A 16-year-old boy with lupus erythematosus and hypogammaglobulinemia developed bacteremia with "Campylobacter upsalinesis," a recently described Campylobacter species with minimal catalase activity. Because "C. upsaliensis" Gram stains poorly and because it is susceptible to antibiotics in standard selective media, it may be overlooked in routine handling of blood cultures.

Kawasaki syndrome

Kawasaki syndrome is an acute multisystem inflammatory disease of young children first described by Tomasaku Kawasaki in the Japanese literature in 1967. He reported 50 cases of this entity under the rubric of acute febrile mucocutaneous lymph node syndrome, a designation that has more recently been superseded by the eponym Kawasaki syndrome. The disorder was further delineated and brought to the attention of American pediatricians in 1974. Recognition of the syndrome followed rapidly, and Melish, Hicks and Larson published the first series of American cases from Hawaii in 1976. Subsequently, Kawasaki syndrome has been documented worldwide. Although the disorder is known to be a systemic vasculitis with predilection for the coronary arteries, the etiology has remained obscure despite intense investigative efforts.

Kawasaki syndrome

Kawasaki syndrome is an acute, self-limited illness of young children which is characterized by prolonged fever, mucositis, skin changes, and cervical lymphadenopathy. Most investigators favor a microbial agent or agents as the trigger of KS followed by an immune-mediated vasculitis with a predilection for the coronary arteries. Serious complications include coronary artery aneurysms, aneurysmal thrombosis, and death. Aspirin has been the conventional treatment for KS, but it has not been shown to alter the basic pathology. Recently intact intravenous gamma globulin has been shown to reduce the frequency of coronary artery abnormalities. Definitive therapy of KS, however, awaits the discovery of its cause and pathogenesis.

Renal papillary necrosis in juvenile rheumatoid arthritis

Three patients who developed renal papillary necrosis while receiving long-term, high-dose aspirin therapy for juvenile rheumatoid arthritis are presented. It appears that aspirin alone or aspirin in combination with other drugs is the causative agent. The incidence and biologic significance of renal papillary necrosis are insufficient to alter the use of aspirin as the drug of choice in management of JRA. It is recommended that all children with JRA be encouraged to drink ample fluids and be followed with periodic urinalysis and blood pressure measurements. Those children who develop hematuria or hypertension should be evaluated by excretory urography.