Background: Pediatric facial nerve palsy is acute and mostly idiopathic; other causes are post-infectious forms. Case presentation: We describe a rare case of facial nerve palsy associated with COVID-19 in a 5-year-old boy. The diagnosis of post-infectious COVID-19-related facial paralysis was made by serology positivity for a previous infection (IgG positive, IgM and IgA weakly positive), in the presence of a negative molecular nasopharyngeal swab and in the absence of other etiologies. Early treatment with steroids (1 mg/day for 7 days followed by tapering) and supportive care solved the problem. Conclusion: In a child with facial paralysis, COVID-19 must be considered as the cause and both nasopharyngeal swab and serology must be performed.

Systemic onset juvenile idiopathic arthritis (SoJIA) is a rare inflammatory disorder characterized by remitting fevers, evanescent rash, generalized lymphadenopathy, hepatomegaly/splenomegaly, and/or serositis. Here we report the case of a 5 years-old girl with SoJIA complicated by severe thrombocytosis. Treatment with the Interleukin-1β (IL-1β) receptor antagonist Anakinra caused a fast reduction of blood platelets and of the associated systemic inflammatory response. Measurement of IL-1β, IL-6 and Tpo plasma levels at different time points confirmed the etiopathogenetic role of IL-1β in causing the thrombocytosis, while Tpo did not appear to be involved and this explains the excellent response to treatment with Anakinra. The excellent response to treatment with the IL-1β receptor antagonist, suggests a key pathogenic role of IL-1β in thrombocytosis as well as in the associated systemic symptoms of inflammation.

An arab four years old boy presented with macrocephaly and autism spectrum disorder (ASD). His father’s head circumference was 64 cm (> 97°C) without any significant behavioral problems. Skin lesions suspected of trichilemmomas was visible on the father’s face. His mother and two brothers had no macrocephaly or other dysmorphisms. The child was born at full term and all the auxological parameters were higher than the 97°C (weight 4365 g, height 55 cm, head circumference 38 cm) but during the boy’s growing up the skull’s circumference showed an increasing trend, going well above the 97°C. The child started to walk alone at 18 months and at 14 months he pronounced only a few words in arabic with a successive progressive language regression. At the age of 3 years and 6 months, a diagnosis of autism spectrum syndrome (ASD) was made. At physical examination, macrocephaly was confirmed (CC 57.5 cm, >97°C) while the other auxological parameters where in a lower range and he showed a characteristic habitus with elongated face shape, rounded forehead, downslanting palpebral fissures with hypertelorism, thin upper lip, pointed chin, angled, rotated auricles, no macroglossia, no skin spots and no other pathologic sign. Ophtalmological examination showed pseudopapilledema from papillary drusen. Brain MRI confirmed macrocephaly and excluded intracranial anomalies. A genetic analysis showed a nonsense variant in the PTEN gene in heterozygosity diagnosis of Cowden Syndrome (CS). The same variant was subsequently performed in the child’s parents showing the same mutation in the father. The child continued the neurodevelopmental and clinical-dermatological follow-up. The baby’s father instead began the oncological follow-up for the risk of developing colon cancer, renal cell carcinoma, papillary and follicular thyroid cancer.