Pediatric emergency medicine trisk 2977 2977

Calcinosis During the period of formation of subcutaneous calcification, children with JDM may develop high fever, chills, and one or more areas of swelling under the skin The inflammation caused by the subcutaneous calcium deposit may be indistinguishable from that of cellulitis or abscess formation, with warmth, erythema, and tenderness Eventually, the lesion may spontaneously extrude calcium, at which time the fever often subsides Although this is the natural history of subcutaneous calcifications, it is often hard to exclude an infectious etiology If doubt exists, needle aspiration of the site may be performed and the fluid examined for calcium crystals and organisms In the face of uncertainty, it is best to treat for infection with antibiotics until culture results are available Incision and drainage or surgical debridement should be avoided, as the inflamed skin rarely heals satisfactorily Complete control of the underlying disease offers the best hope for resolution of calcinosis, although this may be incomplete or may require many years Cardiac Emergencies Although EKG abnormalities may be seen in up to 50% of children with JDM, development of myocarditis is uncommon Involvement of the conduction system by edema and fibrosis leads to electrical abnormalities and dysrhythmias BEHÇET DISEASE BD is a rare vasculitis in children, especially in nonendemic areas such as the United States BD is the only vasculitis that affects both arteries and veins The classical description of BD is a clinical triad consisting of recurrent buccal aphthous ulcers, recurrent genital ulcers, and uveitis with hypopyon In addition to these cardinal features of BD, there are a host of associated clinical manifestations, including arthritis, neurologic involvement, GI manifestations, vascular/thrombotic disease, and various dermatologic lesions, including erythema nodosum and necrotic folliculitis Clinical Considerations Recurrent oral ulcerations are the most common presenting sign and ongoing manifestation of pediatric BD While ulcerative mucocutaneous lesions are far from specific for BD, the oral lesions in BD tend to scar, unlike those associated with inflammatory bowel disease, SLE, chronic oral aphthosis, and Sweet syndrome Although oral and genital ulcers may markedly negatively impact quality of life, there are other less common but more serious complications of BD that may lead to significant morbidity and even mortality Ocular disease can be devastating, ultimately resulting in blindness GI disease can result in perforation Neurologic complications are varied, including headache, meningoencephalitis, idiopathic intracranial hypertension, and quadriparesis Psychiatric symptoms, including depression, personality changes, and memory loss, are also reported Vascular/thrombotic complications are a particularly ominous development in BD patients; these can include dural sinus thrombosis and arterial lesions In one multinational pediatric BD