Eosinophilic pustular folliculitis of infancy is a rare inflammatory disease characterized by recurrent, itchy sterile pustules mainly located on the scalp. Topical agents are mostly effective to suppress the symptoms in the majority of cases. However, systemic agents that are safe for long-term use are required for patients with widespread or resistant lesions. We present a case with eosinophilic pustular folliculitis of infancy whose disease was suppressed with cetirizine but recurred after ceasing the drug. Pediatric DermatologyODYAKMAZ DEMIRSOY Et Al. pustular folliculitis in the literature responsive to systemic antihistamines (cimetidine, cetirizine, and hydroxyzine). [4][5][6] The effect of cetirizine in EPFI is probably due to the antieosinophilic action provided by inhibition of eosinophil migration rather than its well-known mechanism, H 1 receptor blockage. 6Our patient was free of lesions after 2 weeks of systemic cetirizine treatment. As he had a history of frequent flares, cetirizine was continued, and this resulted with remission of the disease for the following 2 months. EPFI is usually a self-limited disease, and most of the patients experience spontaneous resolution by the age of 3 years. 1 Thus, recovery of our patient's disease could possibly be attributed to resolution of the disease at his age rather than the effect of cetirizine. Due to this possibility, we ceased cetirizine after 2 months of treatment, but new itchy lesions appeared on the third untreated day. Achieving remission again by restarting cetirizine at the same dosage strongly supports effect of cetirizine in EPFI.Switching from daily to every other day dosage did not change this effect for the following 8 weeks.In conclusion, cetirizine may be considered in the first-line treatment, especially against EPFI with frequent attacks. Keywords cetirizine, eosinophilic pustular folliculitis, infancy O RCI D Evren Odyakmaz Demirsoy https://orcid.
Pauci-immune glomerulonephritis (GN) is more common in elderly people compared to children and the etiology is not completely understood yet. Antineutrophil cytoplasmic antibody (ANCA) positivity occurs in 80% of the patients. We report a case of a 7-year-old girl who presented with malaise and mildly elevated creatinine diagnosed as ANCA-associated pauci-immune crescentic glomerulonephritis with crescents in 20 of 25 glomeruli (80%). Of these 20 crescents, 12 were cellular, 4 fibrocellular, and 4 globally sclerotic. She did not have purpura, arthritis, or systemic symptoms and she responded well to initial immunosuppressive treatment despite relatively severe histopathology. The patient was given three pulses of intravenous methylprednisolone (30 mg/kg on alternate days) initially and continued with cyclophosphamide (CYC; 2 mg/kg per day) orally for 3 months with prednisone (1 mg/kg per day). In one month, remission was achieved with normal serum creatinine and prednisone was gradually tapered. The case of this child with a relatively rare pediatric disease emphasizes the importance of early and aggressive immunosuppressive treatment in patients with renal-limited ANCA-associated pauci-immune crescentic GN even if with a mild clinical presentation. As in our patient, clinical and laboratory findings might not always exactly reflect the severity of renal histopathology and thus kidney biopsy is mandatory in such children to guide the clinical management and predict prognosis.
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