We conclude that vitamin B12 and folate deficiencies are rare in children with newly diagnosed IBD in the United States and we question whether routine monitoring is warranted. Vitamin A and zinc deficiency are common in patients with newly diagnosed IBD and levels should be assessed at the time of diagnosis so that enteral repletion can commence. Vitamin D deficiency is common in all of the children in the Buffalo, NY, area, and routine screening for this deficiency is warranted.

Background. Takayasu’s arteritis with comorbid chronic recurrent multifocal osteomyelitis and ulcerative colitis is rare in the pediatric population. Treatment with anti-TNF alpha agents such as infliximab has been a successful treatment strategy in adults and can be used effectively in the pediatric population. Case Presentation. We present the case of a 15-year-old Caucasian girl with a history of chronic recurrent multifocal osteomyelitis and ulcerative colitis presenting with hypertensive emergency secondary to Takayasu’s arteritis with middle aortic syndrome. She was treated with corticosteroids and methotrexate and ultimately required infliximab infusions of 15 mg/kg every 4 weeks to successfully control her symptoms and normalize her inflammatory markers. Conclusions. In this case, we discuss the use of infliximab in an adolescent patient with chronic recurrent multifocal osteomyelitis, ulcerative colitis, and Takayasu’s arteritis. The significance of this case is determined by the unique occurrence of all three conditions in a pediatric patient, the important consideration of vasculitis in the differential of a pediatric patient presenting with hypertensive emergency, the need for vigilance for detecting diagnostic clues, signs, and symptoms, knowledge of disease associations when evaluating a patient with a predisposition for autoinflammatory conditions, and the use of increasing doses of infliximab to control symptoms.

Celiac disease is a gluten enteropathy that is treated with dietary elimination of gluten. Exposure to nondietary sources of gluten, which are used in the manufacture of products such as plastics, dental equipment, and cosmetics, can also trigger or exacerbate disease. We report the case of a 9-year-old child who presented with nonspecific abdominal discomfort with abnormal serology for celiac disease. She underwent duodenal biopsies that revealed Marsh 3B histopathology. Despite strict dietary elimination of gluten, she continued to be symptomatic and demonstrate positive serum markers for active disease. It was then discovered that the child was exposed to gluten from her orthodontic retainer that contained a plasticized methacrylate polymer. Gluten is a common additive in plastics. She discontinued its use and demonstrated symptom resolution and complete normalization of serology. All possible sources of gluten, including nondietary, must be considered when managing a child with celiac disease.

Thyroglossal cyst rarely presents with carcinoma formation in the remnants of the thyroid gland. We report a 40 year old male with papillary thyroid carcinoma formation in a thyroglossal cyst. The patient underwent surgical intervention for the cyst. His pathology was positive for thyroid carcinoma and he underwent complete thyroidectomy with postoperative radioactive iodine treatment. His follow up revealed no evidence of recurrence.

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Inflammatory Bowel Disease in Pediatric Patients With Cerebral PalsyT o the Editor: Cerebral palsy (CP) has not been associated with inflammatory bowel disease (IBD). We have diagnosed IBD in 5 children with CP in the last 2 years. We reviewed our pediatric patients seen from 1996 to 2009 at Children's Hospital, Colorado, with CP and/or IBD and identified 13 with CP and newly diagnosed IBD (6 Crohn disease, 5 ulcerative colitis, and 2 indeterminate colitis), providing an estimate of 1.8% (95% CI 0.97-3.08) for frequency of CP in IBD and an estimated cumulative incidence of 193 (95% CI 103-330) cases with IBD per 100,000 patients with CP.IBD patients with CP frequently presented with high white blood cell counts, often received infliximab or tacrolimus in the first month following diagnosis, and commonly developed perianal fistula during follow-up. Therefore, we suggest that CP is possibly associated with an aggressive form of IBD. We estimate a prevalence of CP in our patients with IBD (1.8%) that is higher than reported in the general population (0.36%) (1). The estimated cumulative incidence of IBD in our cross-sectional study of pediatric patients with CP was 193/100,000. Although we cannot explain this relation, potential mechanisms include causes of, or treatments for, CP, including special formula diets, that may affect the gastrointestinal microbiota or function (2); an undefined nutritional deficiency (3); and an altered intestinal environment in some children with CP that predisposes to immune dysregulation (4). The possible association between IBD and CP requires further evaluation in population-based studies.