Kidney involvement has been poorly investigated in SARS-CoV-2 Multisystem Inflammatory Syndrome in Children (MIS-C). To analyze the spectrum of renal involvement in MIS-C, we performed a single-center retrospective observational study including all MIS-C patients diagnosed at our Pediatric Department between April 2020 and May 2022. Demographic, clinical, pediatric intensive care unit (PICU) admission’s need and laboratory data were collected at onset and after 6 months. Among 55 MIS-C patients enrolled in the study, kidney involvement was present in 20 (36.4%): 13 with acute kidney injury (AKI) and 7 with isolated tubular dysfunction (TD). In eight patients, concomitant AKI and TD was present (AKI-TD). AKI patients needed higher levels of intensive care (PICU: 61.5%, p < 0.001; inotropes: 46.2%, p = 0.002; second-line immuno-therapy: 53.8%, p < 0.001) and showed lower levels of HCO3- (p = 0.012), higher inflammatory markers [neutrophils (p = 0.092), PCT (p = 0.04), IL-6 (p = 0.007)] as compared to no-AKI. TD markers showed that isolated TD presented higher levels of HCO3- and lower inflammatory markers than AKI-TD. Our results indicate a combination of both pre-renal and inflammatory damage in the pathogenesis of kidney injury in MIS-C syndrome. We highlight, for the first time, the presence of tubular involvement in MIS-C, providing new insights in the evaluation of kidney involvement and its management in this condition.

Background and Clinical Significance: Scurvy, caused by chronic vitamin C deficiency, is re-emerging in Western countries, particularly among pediatric patients with highly selective diets. While its musculoskeletal and mucocutaneous manifestations are well-known, its association with pulmonary arterial hypertension (PAH) is rare and poorly understood. Ascorbic acid and iron are essential cofactors for prolyl hydroxylases (PHD), which regulate Hypoxia-Inducible Factors. Their combined deficiency may trigger a “pseudohypoxic” state, leading to pulmonary vascular remodeling and vasoconstriction. Case Presentation : A 30-month-old female presented with a one-month history of limping, lower limb pain, and gingival hypertrophy. Dietary history revealed an almost exclusive cow’s milk-based intake. Physical examination showed diffuse petechiae, pallor, and right knee edema. Laboratory findings confirmed scurvy (undetectable vitamin C), severe iron-deficiency anemia (Hb: 72 g/L; ferritin: 22 mcg/L; RDW: 30%), folate deficiency, and hyperhomocysteinemia. Notably, elevated copper and vitamin B12 levels suggested a state of metabolic dysregulation. Echocardiography revealed moderate PAH phenotype (estimated sPAP: 47–50 mmHg) and a hyperdynamic contractility. A “perfect storm” mechanism was hypothesized, involving iron–ascorbate-dependent PHD impairment, high-output state, and oxidative-stress-induced hepcidin dysregulation (suggested by elevated copper). Following intravenous vitamin C and multivitamin supplementation, pulmonary pressures normalized within one week. Conclusions: PAH phenotype in scurvy represents a reversible metabolic disruption of pulmonary vascular tone rather than a structural disease. This case underscores the synergistic role of vitamin C, iron, and folate in vascular homeostasis. Clinicians should maintain high suspicion for scurvy in children with selective diets and unexplained PAH, as nutritional restoration is curative.

A previously healthy 4-year-old boy presented with progressive left eyelid swelling and erythema, without reported animal exposure. Initially diagnosed as impetiginized eczema, the lesion was treated with topical antibiotic and corticosteroid therapy. Due to early clinical worsening, this was subsequently escalated with oral amoxicillin–clavulanate (50 mg/kg/day) and azithromycin (10 mg/kg/day). However, this local and systemic regimen failed and worsened the clinical presentation over a 9-day period. Inflammatory markers and blood cultures remained normal. Due to outpatient treatment failure, an initial periorbital skin and ciliary margin swab was collected on day 9 of oral antibiotics. Two days later, worsening symptoms prompted hospital admission for intravenous broad-spectrum antibiotics (ceftriaxone and clindamycin) and fluconazole. Pending culture results, suspected vesicular lesions led to empirical oral acyclovir (20 mg/kg/dose, 4 times daily); this was discontinued after 3 days when the initial swab returned negative for HSV. Ultimately, after an 8-day incubation, the outpatient swab culture yielded Trichophyton mentagrophytes species complex. Following microbiological identification of the dermatophyte, antifungal treatment was optimized with systemic griseofulvin and topical terbinafine, leading to complete clinical resolution. This case highlights atypical periocular dermatophytosis masquerading as a refractory bacterial and viral infection. Since direct animal exposure was not reported and phenotypic identification alone cannot distinguish between zoophilic (T. mentagrophytes) and anthropophilic (T. interdigitale) subtypes, the exact source of infection remains undetermined. In conclusion, while ‘tinea incognito’ is well documented, this report illustrates an exceptionally atypical periocular manifestation that mimicked a refractory bacterial cellulitis and simulated a herpetic infection. The novelty of this case lies in its severe clinical mimicry—including the development of chalazion-like lesions—which confounded a multidisciplinary team and led to unnecessary systemic antiviral and broad-spectrum antibiotic therapies, strongly highlighting the clinical importance of considering dermatophytosis in atypical orbital presentations.

Advances in respiratory care have significantly extended the life expectancy of patients with Duchenne and Becker muscular dystrophies (DMD/BMD), making progressive dilated cardiomyopathy the leading cause of mortality in this population. Historically, a conservative “watch and wait” approach was often maintained until overt systolic dysfunction became evident. However, the advent of advanced echocardiographic technologies, particularly Global Longitudinal Strain (GLS) imaging, has demonstrated that myocardial impairment begins in early childhood, long before a decline in ejection fraction occurs. This critical evidence strongly advocates for a paradigm shift toward early, proactive cardioprotective strategies. As patients progress into the transitional age and adulthood, the pediatric prophylactic approach (traditionally based on ACE inhibitors and beta-blockers) must integrate with evolving adult heart failure guidelines. This comprehensive review critically evaluates the pathophysiological continuum of dystrophic cardiomyopathy. We highlight the prognostic value of early subclinical detection (GLS) and specifically discuss the transition to modern guideline-directed medical therapies (GDMTs), exploring the emerging role of Angiotensin Receptor-Neprilysin Inhibitors (ARNI, e.g., sacubitril/valsartan) and SGLT2 inhibitors (e.g., dapagliflozin) in this specific cohort. Finally, we address the role of advanced device therapies (ICD, CRT, and left ventricular assist devices) in end-stage disease. By bridging pediatric neurology and adult cardiology, this review aims to equip clinicians with an updated, multidisciplinary framework to optimize cardiovascular outcomes in the growing population of transitional-age DMD/BMD patients.

Background and Clinical Significance: Acute appendicitis following blunt abdominal trauma is a rare and historically debated clinical entity. We present a century-spanning descriptive review of 106 cases of post-traumatic appendicitis, embedded with an illustrative pediatric case initially managed conservatively. Methods: A comprehensive literature review was conducted following PRISMA guidelines across PubMed/MEDLINE, Web of Science, and Google Scholar, encompassing a 100-year period (1925–2025). Clinical variables, trauma mechanisms, and outcomes were extracted and statistically analyzed by age cohort (Pediatric ≤ 18 vs. Adult > 18) and historical medical era. Results: A total of 106 cases were analyzed. High-energy trauma predominated in adults compared to the pediatric cohort (48.8% vs. 18.5%, p = 0.001). The overall complication rate was exceptionally high (66.0%), with no significant difference between pediatric and adult cohorts (61.5% vs. 73.2%, p = 0.293). An epoch-based analysis revealed a significant drop in perforation rates from the historical era (1925–1980) to the modern era (2001–2025) (51.7% to 27.0%, p = 0.033) due to improved diagnostic timelines. Crucially, purely mechanical injuries such as complete appendiceal auto-amputation remained a constant signature of blunt trauma across the century (11.5% overall rate). Conclusions: Our synthesis of historical cases suggests that post-traumatic appendicitis might be a relevant clinical entity where trauma mechanics appear to play a significant role in injury severity, irrespective of patient age. While conservative management could be feasible and safe in the acute setting of uncomplicated cases, we hypothesize that the initial kinetic impact might cause subtle structural changes or alter local appendiceal dynamics, potentially predisposing the organ to recurrent inflammation, warranting close follow-up or elective surgery.

Background/Objectives: Isolated Left Ventricular Apical Hypoplasia (ILVAH) is a rare congenital anomaly characterized by a truncated, spherical left ventricle (LV) with fibro-fatty apical replacement. Historically considered a benign condition of asymptomatic adults, its hemodynamic behavior under physiological stress remains poorly characterized. We present two distinct cases and a comprehensive literature review (n = 59) to redefine the clinical spectrum of ILVAH. Methods: To contextualize our findings, a comprehensive review of the literature was performed up to February 2026. We searched the PubMed/MEDLINE database using the terms “Isolated Left Ventricular Apical Hypoplasia”, “ILVAH”, “truncated left ventricle”, and “left ventricular apical hypoplasia”. The literature search and study selection were conducted in accordance with the PRISMA guidelines. Case presentations: Case 1 describes a male infant with ILVAH and muscular ventricular septal defects who unexpectedly developed transient systolic heart failure at one month of life, requiring prompt medical therapy (ACE inhibitors and diuretics) for functional recovery. Case 2 describes a 33-year-old woman with a known diagnosis of ILVAH. Serial echocardiography during her first pregnancy revealed progressive left atrial dilation and the onset of mild post-capillary pulmonary hypertension. Immediately following an elective cesarean section at 37 weeks, she experienced acute heart failure. She was successfully managed with pre-emptive volume offloading. Conclusions: ILVAH is not a universally benign anomaly. The morphologically deficient and rigid ventricle is vulnerable to afterload shifts in infancy and rapid volume expansion in adulthood. A review of all previously reported pregnancies in ILVAH reveals a consistent pattern of severe, unrecognized postpartum pulmonary edema. Proactive, multidisciplinary management is suggested to prevent clinical decompensation. Our findings suggest that ILVAH may act as a stress-sensitive restrictive congenital left ventricle disease rather than a universally benign anatomical variant, a hypothesis that warrants further investigation.