Septic osteomyelitis in children is sometimes challenging for physicians to diagnose. The diagnosis often is unclear at the initial evaluation. The initial presentation may be nonspeci c. Children older than 3 months of age with hematogenous osteomyelitis usually present acutely with fever, constitutional symptoms (eg, irritability, decreased appetite or activity). Close monitoring of the clinical course is essential to establishing the diagnosis.
We are presenting a rare case of overlap of Sjögren's syndrome (SS) and Celiac disease (CD). It is necessary to evaluate and diagnose timely the possible presence of other autoimmune diseases in the presence of any autoimmune disease, because they have about a 25% risk of developing several of them at the same time, which is called overlap syndrome. It is very important to do screening, follow up and regular GI care of Sjögren's syndrome patients to identify CD case and help them to avoid severe malnutrition, hyponatremia, anaemia and later intestinal malignancies.
Many common diseases known to us initially have unusual, non-specific clinical manifestations, making diagnosis difficult. We presented cases from our practice where the so-called "Overlap" clinical manifestation occurred. Specifically, a 10-year-old boy with recurrent fever and hemorrhagic rash, with history of epilepsy, and a 5-year-old boy with pleuropneumonia and thrombocytopenia.
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