No abstract

The Schӧnlein-Henoch vasculitis is an IgA-mediated inflammation of small vessels. The main clinical manifestation is palpable purpura without thrombocytopenia, manifested by bilateral symmetrical distribution on both lower limbs, abdominal pain, often accompanied by blood in the stools, hematuria with / or without proteinuria. Historically, the disease has been known since 1832. In Bulgaria, although that later Henoch-Schӧnlein purpura (HSP) aroused scientific interest, several publications focused on the pathogenic nature, clinical variations, and potential complications of the disease, as well as options for therapeutic intervention. Modern knowledge about the etiology and pathogenesis of the disease has given new light, respectively a basis for early diagnosis, reduction of complications and recurrences, as well as the avoidance of polypragmatism. It turned out that in HSP there are genetic factors and new aspects, binding until now accepted concept that there are no changes in the coagulation system. The role of factor XIII, as a prognostic indicator of the severity of clinical manifestations and von Willebrand factor (vWF), as a reliable index of the degree of vascular wall damage, has been demonstrated. Plasma imbalance in the Th1 / Th2 ratio was also found and a percentage of NK cells, respectively their immune function, were reduced. This new knowledge about the pathogenic nature of HSP is the basis for a change in the concept of therapeutic behavior, which is aimed at the severity of the clinical course, and not only at the treatment of the disease, which is itself symptomatic.

Burkitt lymphoma is a highly aggressive form of Non-Hodgkin lymphoma that responds favorably to early treatment. The disease has many forms of clinical presentations. It is diagnosed in children usually as an abdominal mass. The tumor causes either indirect symptoms, due to pressure phenomena or direct involvement of the bowel lumen leading to either intestinal obstruction or intussusception. We report a case of a 6-year-old immunocompetent Caucasian boy who experienced a recurrent abdominal pain (RAP) for the last four months. After symptoms of bowel obstruction, we operated on him at the Department of Pediatric Surgery and ileocolic intussusception was found. We performed right colectomy. Sectioning the invaginate we found a tumor, spreading from the terminal ileum and involving the ileocecal valve. The tumor was immunohistochemically verified as Burkitt lymphoma. CT of neck, mediastinum and abdomen showed polyadenopathy. The child was referred to the pediatric hematology center for chemotherapy. Conclusion: Burkitt lymphoma rarely causes recurrent abdominal pain in children. The common presentation are bowel obstruction and intussusception. The possibility of lymphoma should be considered in case of intussusception in older children. Therapeutic approach includes combination of surgery and chemotherapy.

The incidence of COVID-19 in children has been variable. Although now the number of infected children worldwide, and in particular nationally, is small, they are not protected from the infection. Moreover, in the most severe cases septic shock, metabolic acidosis, irreversible bleeding, and coagulation dysfunction have been registered. In February 2021 a 17-year-old boy showed for examination with complaints of pain in the upper part of the abdomen, accompanied by involvement of the ankle joints, the appearance of a rash on the lower extremities with the characteristic of hemorrhagic vasculitis, and a positive test for COVID-19. The characteristics of the skin purpura, the abdominal pain, and the arthralgia led us to the diagnosis of Schönlein-Henoch purpura. The verification of past COVID-19 infection was done by the established high titer of specific IgG antibodies. The clinical evolution of the disease went beyond its generally accepted benign nature - the first manifestation of the illness had been followed by four more relapses, which necessitated new hospitalizations and a change in the therapeutic approach. COVID-19 infection is the cause of a more aggressive course of vasculitis.

First encountered in the 2019 COVID-19 virus has a high transmission capacity, and children are not spared. Therefore, we set a goal, referring to the experience of the countries in which the infection spread the earliest and widest, to make a summary of the characteristics of COVID-19 in the pediatric population. Of course, the most significant thing is the variation in the clinical manifestation, the correct assessment of the clinical risk of lung damage, as well as the laboratory and imaging methods of examination that support a reliable diagnosis. The therapy section of the article describes all the possible strategies for therapeutic behavior. Despite the rapidly growing theoretical information and shared clinical experience, the article could be a foundation on which to add and expand theoretical and practical knowledge.