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Crohn's disease belongs to the group of autoimmune diseases, known as inflammatory bowel disease. The inflammation may span the entire depth of the intestinal wall. In effect the typical complications of Crohn's disease can be the formation of fistulas: external (perianal, between the bowel and skin) and internal (between two loops of bowel, between the bowel and bladder, between the bowel and vagina). These complications may occur in about 30–40% of patients. The study describes a 17-year-old patient hospitalized for recurrent urinary tract infections. The first symptoms of the disease were tonic abdominal pain, anemia, recurrent diarrhea, fever of unknown etiology. The cause of these problems was a urinary tract infection, which persistently recurred despite aggressive treatment. After the transfer to the Department, the diagnostic process revealed the suspicious thickening of the walls of the ileum. The diagnostics was expanded in the direction of inflammatory bowel diseases. In addition to urinary tract infections, Crohn's disease was diagnosed and confirmed. Owing to persistent dysuria, a fistula between the bowel and bladder was suspected. After confirmation of this diagnosis a parenteral nutrition was applied and the treatment was continued in the Department of Gastroenterology. This case illustrates the potential difficulties in identifying the cause of urinary tract infections and shows the need for an accurate diagnostic process, especially in cases of recurrent. The cause can sometimes be very surprising.

Salicylate intoxication is possible by ingestion and topical application of creams or lotions. Symptoms of salicylate poisoning include: vomiting, abdominal pain, fever, dizziness and hallucinations. Moreover metabolic acidosis or coagulations disorders can be observed. In case of severe poisoning potential symptoms may include: acute renal failure, pulmonary edema and gastrointestinal bleeding. As there is no antidote, only symptomatic treatment such as : gastric lavage, supplying with active carbon and advocated alkaline diuresis can be applied. Compensation of acid-base and electrolyte fluctuations may be of crucial importance. This paper presents the case of a 7-year-old girl, who was admitted to Department of Pediatric Cardiology and Nephrology at University of Medical Sciences in Poznan, due to intoxication by salicylates. Before hospitalization the patient was treated with 30% salicylate ointment because of scabies. After dermatological consultation, the medication was applied twice a day on whole skin except the face, without cleaning (for next three days). Patient received a total dose of 30 g of salicylic acid. First symptoms appeared after 24 hours of the first application. She was admitted to neighboring Hospital, where the preliminary diagnosis was gastro-intestinal infection. Next day the patient started to present neurological symptoms. She was transported to another hospital, where measurement of salicylates level in serum was performed. Finally the patient was admitted to Department of Pediatric Cardiology and Nephrology in Poznan for hemodialysis, due to very high, toxic level of salicylates (7 times higher than therapeutic dose of the drug). Gradual reduction of the concentration of salicylic acid in the blood serum was accompanied by clinical improvement of the patient. Because of high ratio of the skin surface to the body weight as well as clinically significant absorption into the body, substances topically applied on children with low safety margin should be dosed with caution.

Streszczenie Toczen rumieniowaty ukladowy (SLE) jest autoimmunologiczną chorobą tkanki lącznej o szerokim zakresie objawow klinicznych. U dzieci choroba wystepuje znacznie rzadziej niz u doroslych, ale az u 70–80% z nich wystepuje toczniowe zapalenie nerek (NT), ktore jest jednym z najpowazniejszych czynnikow rokowniczych SLE. W celu indukcji, a nastepnie podtrzymania remisji choroby stosowane jest intensywne leczenie immunosupresyjne obarczone mozliwością wystąpienia powaznych skutkow ubocznych. Cel pracy Celem pracy byla retrospektywna analiza przebiegu i wynikow leczenia toczniowego zapalenia nerek u dzieci. Material i metody Grupe badaną stanowilo 10 dzieci hospitalizowanych w Klinice Nefrologii Dzieciecej UM w Poznaniu. Analizowano objawy kliniczne, parametry laboratoryjne oraz wyniki leczenia immunosupresyjnego w okresie 24 miesiecy. Wyniki Średnia wieku w chwili zachorowania wynosila 14 lat i 3 miesiące. Wśrod pacjentow przewazaly dziewczynki. U 7 dzieci nefropatia toczniowa wystąpila w postaci zespolu nerczycowego, a u 6 jako ostra niewydolnośc nerek. U 7 pacjentow stwierdzono IV klase NT wg klasyfikacji WHO. W leczeniu stosowano steroidy (GK), cyklofosfamid (CF), cyklosporyne (CsA), plazmaferezy oraz u 3/10 mykofenolan mofetylu (MMF). U 2 chorych stosowano CsA w indukcji remisji. Wszyscy pacjenci uzyskali remisje kliniczną i biochemiczną w okresie indukcji. U 3 pacjentow leczonych MMF remisja wystąpila w pierwszych trzech miesiącach leczenia. Wnioski NT u dzieci przebiega z duzą aktywnością kliniczną oraz postepującą glomerulopatią, ktora wymaga intensywnego leczenia immunosupresyjnego. Zastosowanie MMF w okresie indukcji remisji moze przyspieszyc osiągniecie remisji oraz prowadzic do ograniczenia liczby pulsow cyklofosfamidowych i wydluzenia okresu remisji.