Tuberculosis (TB) is still a significant public health problem in Korea. In many cases, it is not easy to diagnose TB. A 13-year-old male patient was admitted for left chest pain for 6 months period. Chest radiography done two months ago during the school screening revealed a pleural effusion in the left lung. All cultures were negative, and 3 sputum samples and his pleural fluid sample tested negative for Acid-fast bacilli. There was no evidence of a malignant effusion. A pleural fluid examination revealed features suggestive of an empyema. Thick and yellowish pus was drawn out. Pleural fluid analysis presented White blood cell 5,200/mm3, and neutrophil-dominant with 60% of neutrophil. In an effort to attain a diagnosis, a video-assisted thoracoscopy procedure was performed with pleural drainage and biopsies. Active chronic granulomatous pleuritis was found through pleural biopsies. He was responsive to treatment and received 6 months of anti-TB therapy with complete clinical resolution. If the clinical picture is in confusion, pleural biopsy is occasionally indicated to diagnose TB pleuritis.

Eosinophilic gastroenteritis (EGE) is a rare inflammatory disorder that predominantly affects the stomach and the small intestine, although its pathogenesis is not yet known precisely. EGE shows distinct peripheral eosinophilia and eosinophilic infiltration of the intestinal wall. A 12-month-old girl who was breastfeeding presented with bilateral eyelid swelling without gastrointestinal symptom. Laboratory examination showed peripheral eosinophilia and hypoalbuminemia and iron deficiency anemia. Gastric and duodenal biopsy specimens revealed eosinophilic infiltration of the mucosal layer. We experienced a case of eosinophilic gastroenteritis without any gastrointestinal symptom, associated with maternal food contained allergen.

Acute disseminated encephalomyelitis (ADEM) is a rare, postinfectious autoimmune inflammatory demyelinating disease of the central nervous system. ADEM presents clinically encephalopathy in association with polyfocal neurologic deficits. Of them, optic neuritis is less common symptom. We experienced ADEM with optic neuritis associated with Mycoplasma pneumoniae infection in a 5 year-old girl. She initially presented lethargy, irritability, ataxia and loss of pain sense on right hand and progressed to decreased visual acuity and papilledema of both eyes on the 4th hospital day. Brain magnetic resonance imaging showed multiple bilateral hyperintense lesions in the subcortical white matter on T2 weighted images. After administration of intravenous immunoglobulin and high dose intravenous methylprednisolone, she recovered completely.

There are very few reports and limited evidence that premedication with steroids decreases early recurrence of ileocolic intussusception after a successful hydrostatic reduction. The purpose of this study was to examine the role of steroids in decreasing early recurrence of idiopathic intussusceptions. A retrospective review of children that underwent successful hydrostatic reduction was conducted. Two groups were identified: group 1 (38 cases) that received intravenous methylprednisolone (1 mg/kg/dose) on diagnosis or immediately after the reduction maneuver, and group 2 (59 cases) were not given. There were 60 boys and 37 girls ranging in age from 6 to 84 months. There were no statistical differences between the groups regarding age, sex, duration of symptoms and laboratory findings on admission. There was no significant difference (p=0.76) in the rate of early recurrent intussusception between the steroid group (15.8%, 6/38) and the non-steroid group (13.6%, 8/59). We found that premedication of children with idiopathic intussusception with methylprednisolone did not decrease early recurrence of idiopathic intussusceptions.

The aim of this study was to determine the effect of acute respiratory viral infection on Kawasaki disease. From July 2016 to June 2018, among the patients who underwent respiratory virus screening at the Kwangju Christian Hospital, those diag-nosed 88 patients with Kawasaki disease were enrolled in this study. The effects of acute respiratory viral infection on Ka-wasaki disease were compared according to whether 2nd intravenous immunoglobulin (IVIG) treatment was administered or not, and whether coronary artery complications occurred. Respiratory virus was detected in 44 out of 88 patients. 2nd IVIG treatment rates were 16% (n=7) and 27% (n=12) in the virus positive group and the virus negative group, respectively (p>0.05). The incidence of coronary artery complications was 11% (n=5) and 25% (n=11) in the virus positive group and the virus negative group, respectively (p>0.05). There was no statistically significant correlation between the 2nd IVIG admin-istration and coronary artery complications following the detection of respiratory virus in patients with Kawasaki disease. We think it is necessary to actively study the effects of acute respiratory viral infection on Kawasaki disease through large-scale studies of multiple centers in the future.

The aim of this study was to investigate the factors associated with cerebrospinal fluid (CSF) pleocytosis in pediatric enteroviral meningitis. A retrospective analysis of the medical records was performed in 281 patients under 18 years of age who were diagnosed with enteroviral meningitis by reverse transcription-polymerase chain reaction (RT-PCR) at Kwangju Christian Hospital from January to December 2016. Clinical symptoms and laboratory findings were compared according to the presence or absence of CSF pleocytosis. 112 children (39.9%) did not have CSF pleocytosis. When we compared the group of meningitis without pleocytosis and the group with pleocytosis, age were younger (< 2years), and the interval between onset of symptoms and the time of lumbar puncture was shorter (<24 hours), peripheral white blood cell counts were lower, but C-reactive protein (CRP) was higher in the group of meningitis without pleocytosis. Enteroviral meningitis should not be excluded even if CSF pleocytosis is not seen in patients. And enterovirus CSF RT-PCR should be performed with high suspicion in children younger than 2 years.

Genetic factors are increasingly found as potential causes of children with acute recurrent pancreatitis (ARP) or chronic pancreatitis (CP). Representative genes include cationic trypsinogen, serine protease 1 (PRSS1), serine protease inhibitor Kazal type 1 (SPINK1), cystic fibrosis transmembrane conductance regulator (CFTR), chymotrypsin C (CTRC) and calcium sensing receptor (CASR) genes, etc. In Korean children, PRSS1 and SPINK1 genes have been most commonly studied, while CFTR mutations were reported in one patient to date. We report a case of a 13-year-old male adolescent with CP with CFTR mutations. Since he was first diagnosed with idiopathic acute pancreatitis (IAP) based on laboratory and computed tomographic findings, he was admitted with ARP and CP over four times in a year at the secondary and tertiary hospital. No etiology was detected by several examinations including magnetic resonance cholangiopancreatography (MRCP), endosco-pic retrograde cholangiopancreatography (ERCP), endoscopic ultrasonography (EUS) with fine needle aspiration (FNA) biopsy and genetic test including PRSS1 and SPINK1. Although he had no typical symptoms associated with cystic fibrosis (CF), CFTR mutations were detected with additional gene examination. Testing for CFTR mutations should be concerned in pediatric patients with APR and CP without other identified causes.

There are reports that inhaling hypertonic saline with bronchodilator is helpful in the treatment of bronchiolitis. However, further studies are needed to determine if it is helpful to inhale hypertonic saline with bronchodilator in children with recurrent wheezing. We aimed to investigate the effect of hypertonic saline inhalation in children with recurrent wheezing. A total of 40 patients under 6 years of age admitted to Kwangju Christian Hospital from December 2014 to May 2016 were enrolled. Patients were randomly assigned to receive salbutamol. In the control group (n=21), salbutamol (2.5-5 mg / 0.5-1 mL) was inhaled four times a day with physiological saline (0.9% normal saline 1-3 mL). In the experimental group (n=19), the same amount of hypertonic saline (5% saline 1-3 mL) was inhaled four times a day instead of physiological saline. We compared the duration of wheezing remission between patients who had recurrent wheezing (n=40). There was no difference in the duration of wheezing remission in patients who had recurrent wheezing. But the hypertonic saline inhalation group had a lower post treatment clinical score on the 2nd-3rd day of admission than the physiological saline inhalation group. In this study, hypertonic saline inhalation therapy was not significantly effective in the treatment of recurrent wheezing. More additional research is needed to determine whether inhaled hypertonic saline is effective in the treatment of recurrent wheezing.

The study aimed to evaluate the usability of sterile bag collection (SBC) urinalysis and urine culture for diagnosing urinary tract infections (UTI). Urine culture is key for diagnosing UTI, and transurethral catheterization (TUC) or suprapubic aspiration is recommended for non-toilet-trained children. Although urine testing using SBC is non-invasive and easy, UTI can be diagnosed only if other criteria including clinical symptoms and positive urinalysis results are met. This study included 228 infants who were hospitalized for unexplained fever from October 2015 to June 2016. TUC culture, SBC urinalysis, and urine culture were performed for all patients. UTI was diagnosed when the TUC culture results met the criterion of ≥104 colony-forming units (CFU)/mL. When UTI diagnosis was made based on SBC urine colony counts ≥105 CFU/mL, the false-positive and false-negative rates were 6.3% and 70.0%, respectively. When the criterion was set as ≥104 CFU/mL, they were 23.7% and 30.0%, respectively. When both the criteria of ≥105 CFU/mL and positive urinalysis results were met, the false-positive rate was 2.4%, and the false-negative rate was 80%. Our results suggest that diagnosing UTI using SBC urinalysis and urine culture is not useful in infants with unexplained fever.

This study aimed to identify the respiratory viral etiology and clinical features in febrile neonates and young infants younger than 3 months of age. From June 2015 to March 2016, 126 patients who admitted to the pediatrics department of Kwangju Christian Hospital due to febrile illness (body temperature ≥ 38.0℃) without definite focus of fever. We tested nasopharyngeal aspiration specimens with real time reverse transcriptase polymerase chain reaction. Respiratory viruses identified in 66 patients, and not identified in 60 patients. Among identified viruses, the most common pathogen was rhinovirus. Respiratory virus identified patients showed significantly higher presence of sibling (p=0.015), sibling who attending day care center (p=0.022), respiratory symptoms of family members (p=0.022), concomitant respiratory symptoms of the patient (p=0.001).

Enterobius vermicularis is one of the most common parasites in the world and the infection rate is higher in children than adults. Although the most common clinical manifestation is perianal pruritus, it may cause other gastrointestinal manifestations. We report one case of appendicitis caused by Enterobius vermicularis. The clinical difference between typical appendicitis and the appendicitis due to Enterobius vermicularis is unclear. The patient had a repetitive Enterobius vermicularis infection for a past year, which was treated with occasional vermicides only. It is considered that the appendicitis is developed from the intractable Enterobius vermicularis infection.

The intussusception recurs in approximately 10 percent of children after successful nonoperative reduction. The main objective was to determine the clinical and sonographic findings that could be used to predict recurrence of ileocolic intussusception in children that had been successfully reduced by enema. A retrospective search was performed on 66 children, at age of 3 months to 7 years, with successful enema reduction of intussusception during a 2.5-year period from January 2013 to July 2015. The clinical, laboratory records, and sonographic findings were compared between recurrence of intussusceptions group (ROI) and non-recurrence group (NROI). Statistical significances were found in age (median, 26.0 vs 18.5 months; P =0.022) and terminal ileal wall thickening (mean, 10.23 vs 7.8 mm; p=0.002); in contrast, there was no significance considering gender, irritability (p=0.074), currant jelly stool (p=1.0), or C-reactive protein (p=0.908). Recurrence is associated with age and the thickening of terminal ileal wall, but clinical or laboratory findings. Given the small number of cases, further studies should be conducted.

The present study aimed to identify the factors that can clinically predict responses to macrolides treatment in patients with Mycoplasma pneumoniae pneumonia. Of the patients admitted to the pediatrics department of Kwangju Christian Hospital during December 2012 to March 2015, 195 patients who had pneumonia according to findings of chest radiography, positive Mycoplasma IgM, and fever at the time of admission were selected as study subjects. Patients were divided into one group wherein the duration of fever after macrolides treatment was 3 days or less and another group wherein the duration of fever was 4 days or more (169 patients [86.7%] vs 26 patients [13.3%]). In the group with fever duration of 4 days or more, a greater number of patients had a history of atopic dermatitis (3.6% vs 15.4%, p=0.11), and the symptom duration before admission was longer (cough: 4.04 days vs 6.38 days, p<0.001; fever: 3.96 days vs 6.08 days, p<0.001). Moreover, according to laboratory test results in the group with fever duration of 4 days or more, LDH levels were high (648.16 IU/L vs 829.92 IU/L, p=0.001), and there was a significant correlation between LDH levels and the duration of fever after macrolides treatment.