Introduction: House dust and storage mites are allergens associated with allergic rhinitis and asthma. Oral mite anaphylaxis manifests after ingesting contaminated flour with mites. We present the case of a 13-year-old child who developed anaphylaxis after consuming pizza. Case presentation: A 13-year-old boy presented with respiratory distress after consuming pepperoni pizza, which he had previously tolerated. Skin prick and specific IgE test results revealed sensitization to house dust and storage mites. He passed an oral food challenge (OFC) for pepperoni pizza. Discussion: Anaphylaxis to foods contaminated by mites (also known as “pancake syndrome”) is often overlooked. In this case, the diagnosis was supported by the skin prick tests and specific IgE, although the flour used for pizza preparation could not be tested. The patient passed an OFC using ingredients from a different source. Conclusion: Oral mite anaphylaxis is an unusual presentation that must be considered when other possible food allergy triggers have been excluded and the patient is sensitized to mites.

SARS-CoV-2 infection is associated with respiratory complications, especially during the acute phase. We report an unusual case of an adolescent boy who presented with cough, dyspnea and unilaterally absent breath sounds on auscultation. Two weeks prior to the admission, the patient reported...

Chronic anemia is commonly diagnosed in older adults and serves an important indicator of both reactive and clonal conditions. Many underlying diseases, such as myelodysplastic syndromes and multiple myeloma, are more prevalent amongst the elderly, while novel therapeutic approaches have transformed pediatric disorders of poor prognosis, such as beta-thalassemia, to a chronic disease of older adults. Thus, the increasing prevalence of chronic anemia in older ages is largely attributed to more frequent diagnostic and therapeutic evaluations and demographic changes. The etiology of anemia in adults is complex, ranging from genetic mutations to bone marrow failure syndromes, chronic kidney disease, nutritional deficiencies, and inflammatory processes, while in some cases no clear etiology is found. For this reason, extensive research is ongoing to introduce novel therapeutic targets and improve quality of life. Management of anemia in adults depends on severity and especially on the underlying conditions of each patient. Metabolic pathway analyses have revealed alterations in various pathways, including glycolysis, pyruvate, propanoate, glycerophospholipid, galactose, fatty acid, starch, and sucrose metabolism along with fatty acid elongation in mitochondria, glycerolipid, glyoxylate, and dicarboxylate metabolism in adult patients with chronic anemia compared to healthy individuals, which may serve as potential new therapeutic targets. In this review, we aim to (i) summarize current evidence regarding metabolic disturbances in diseases of age-related hematopoietic dysregulation, being represented by multiple myeloma and myelodysplastic syndromes, and in β-thalassemia, a disease model of accelerating cellular aging; and (ii) describe novel therapeutic metabolic-targeted options for the aforementioned diseases, focusing on the need for continuous research in this field.

There is disagreement on the associations between chorioamnionitis and pneumonia/sepsis, respiratory distress syndrome (RDS), and bronchopulmonary (BPD)dysplasia, three pulmonary outcomes of concern for preterm newborns. Determining clear correlations is challenging due to the intricacy of the prenatal, postnatal, and therapeutic practices that affect the diagnosis of RDS, pneumonia/sepsis, and BPD, two long-term outcomes, as well as their short- and long-term consequences. Owing to the interconnected nature of the variables, the vaguely defined fetal exposures, and the imprecise identification of disorders like RDS and BPD, multivariant studies of huge data sets are unreliable methods for defining associations. On the other hand, research using animal models offers reliable data regarding the effects of exploratory chorioamnionitis on the fetal lung. Understanding the clinical intricacy and the experimental consequences of chorioamnionitis together will help us understand on the impact on the fetal lung .

Myeloperoxidase antineutrophil cytoplasmic antibody (MPO-ANCA) microscopic polyangiitis is a rare but life-threatening small vessel vasculitis in childhood that affects multiple systems. Emerging clinical evidence suggests a possible association between SARS-CoV-2 infection or multisystem inflammatory syndrome in children (MIS-C) as well as the future development of autoimmune diseases. A 14-year-old boy with a diagnosis of MIS-C two years prior to presentation was admitted to our hospital due to edema and left lower limb joint pain along with concomitant upper surface petechia. The patient had a positive higher SARS-CoV-2 IgG than MIS-C diagnosis titers and MPO-ANCA-positive antibody titers. Kidney biopsy favored a pauci-immune crescentic glomerulonephritis. Restrictive lung disease with concomitant diffusion abnormalities was also observed. Pancreatitis and gastrointestinal wall edema were additional clinical manifestations. SARS-CoV-2 breakthrough infection and MIS-C could contribute to the onset of autoimmune vasculitis through various immunological mechanisms. Further research is still needed to elucidate the role of SARS-CoV-2 in the pathophysiology of newly diagnosed autoimmune vasculitis.

The thymus plays a central role in T-lymphocyte maturation and in maintaining immune defense against infections and autoimmunity. We describe three boys (mean age 7.3 years) who underwent total thymectomy during surgical correction of congenital heart disease, two in infancy and one in the neonatal period. Patient A presented (14 years old) with recurrent cervical lymphadenopathy, generalized Epstein-Barr virus (EBV) infection, and hepatic fibrosis. Patient B (two-year-old) developed splenomegaly and had a history of frequent lower respiratory tract infections and pseudohypoaldosteronism type II. Patient C (seven-year-old) presented with generalized lymphadenopathy, hepatosplenomegaly, neutropenia, and thrombocytopenia; his medical history included skeletal anomalies and immune cytopenia with response to intravenous immunoglobulin, but no severe infections. All three patients displayed significantly low naïve CD4 counts, confirming the existence of long-term immune changes following thymectomy. They shared the same immunophenotype, characterized by significantly low naive CD4 cells, which is considered a marker of long-term immune dysregulation following thymectomy. However, their clinical presentation varied, encompassing a spectrum of manifestations ranging from recurrent viral infections to severe immune cytopenias. The immunophenotypic similarities to 22q11.2 deletion syndrome underscore the need to include surgical thymectomy in the differential diagnosis of T-cell dysregulation. Notably, the most severe immune abnormalities were seen after thymectomy during the neonatal period, emphasizing the crucial influence of surgical timing. Long-term immunological monitoring of these children is warranted to anticipate and manage infections or immune-mediated complications.