Coronavirus disease 2019 (COVID-19) patients exhibited protean clinical manifestations. Olfactory and gustatory abnormalities (anosmia and ageusia) were observed in COVID-19 patients, but the reported prevalence varied. In this systematic review, the prevalence of olfactory and gustatory abnormalities (OGA) was evaluated in laboratory-confirmed COVID-19 patients. On 8 May 2020, 14,506 articles were screened, while 12 of them were enrolled. A total of 1739 COVID-19 patients were analyzed, with a wide range of prevalence observed (5.6–94%). The pooled prevalence was 48.5% with high heterogeneity (I2, 98.8%; p < 0.0001). In total, 15.5% had OGA as their first symptom (I2, 22.6%; p = 0.27) among the patients analyzed. Contradictory to COVID-19 negative controls, patients with COVID-19 had a higher risk of OGA (odds ratio, 5.3; I2, 66.5%; p = 0.03). In conclusion, approximately half of COVID-19 patients had OGA, and one-seventh of them had OGA as their initial symptoms. OGA were cardinal symptoms of COVID-19, which may serve as clues for early diagnosis. Diagnostic testing for SARS-CoV-2 was suggested in patients with OGA during the COVID-19 pandemic to ensure timely diagnosis and appropriate quarantine.

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Objective:Pediatric acute pancreatitis (AP) may be different from adult AP in various respects. This study focuses on the epidemiology and medical resource use of pediatric AP in Taiwan.Methods:Patients aged 0 to 18 years with AP were identified from the Taiwan National Health Insurance Research Database based on the International Classification of Diseases, Ninth Revision code of AP 577.0. The medical resource use was measured by length of hospital stay and hospital charges.Results:Between 2000 and 2013, a total of 2127 inpatient cases of pediatric AP were collected, which represented a hospitalization rate of 2.83 per 100,000 population. The incidence by age had 2 peaks, the first peak was at age 4 to 5 years old, and the second one started rising from 12 to 13 years old until adulthood. The incidence by year increased from 2.33 to 3.07 cases per 100,000 population during the study period. The average hospital stay is steady, but the medical cost is increasing. Girls have longer hospital stays, higher medical expenditures, more use of endoscopic retrograde cholangiopancreatography possibly due to more comorbidities with biliary tract diseases than boys (P < 0.05). The mortality in cases of AP is mostly associated with systemic diseases rather than AP itself.Conclusions:The incidence of pediatric AP in Taiwan is in a rising trend. There are gender differences in length of hospital stay, medical costs, use of endoscopic retrograde cholangiopancreatography and comorbidities.

A 9-year-old girl with a 5-day history of fever and headache presented to our emergency department. She did not report rhinorrhea, cough, abdominal pain, vomiting, or diarrhea. Physical examination revealed bilateral neck lymphadenopathy and nonpruritic macular rashes over her trunk and arms (Figure 1; available at www.jpeds.com). A painless papule was located on the buttock and eschar was diagnosed (Figure 2). Blood tests showed thrombocytopenia and elevated liver function

A 6-year-old girl with congenital cataract had experienced intermittent chest pain and dysphagia for 2 years. An upper gastrointestinal contrast study showed dilatation of the esophagus without radiological evidence of achalasia. For determining the etiology, computed tomography was performed and revealed dilatation with circumferential wall thickening of the entire esophagus (Fig. 1). Esophagogastroduodenoscopy found Los Angeles grade B reflux esophagitis. Endoscopic biopsy confirmed esophageal leiomyomatosis. In addition to microscopic hematuria, Alport syndrome was diagnosed. Esophageal manometry revealed elevated integrated relaxation pressure and 100% failed peristalsis during liquid swallows, confirming type 1 esophageal achalasia (Fig. 2). Her symptoms subsided after treatment with lansoprazole and bethanechol for 6 months.Alport syndrome is a clinically and genetically heterogeneous disease characterized by kidney disease, sensorineural deafness, and ocular abnormalities (1). A subset of patients with Alport syndrome have esophageal leiomyomatosis, which is characterized by the proliferation of esophageal smooth muscle and thickening of a considerable portion of the esophagus (2,3). Esophageal leiomyomatosis can cause esophageal achalasia presenting as dysphagia (2-6). Surgical intervention with partial or subtotal esophageal resection and replacement is recommended in such patients (3). According to the clinical course of the present patient, conservative treatment might be helpful for relieving symptoms in patients with Alport syndrome and esophageal leiomyomatosis.