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International audience; The case of a five-year-old boy with macrophage activation syndrome and Epstein-Barr virus infection is reported. Several unusual features were found, including an early major increase in IgA levels, persistent oligoclonal gammapathy, and delayed development of anti-EA antibodies accompanied with an increase in anti-VCA antibodies. Despite the negative family history, an immune deficit and Purilo syndrome are discussed as possible diagnoses in this child.

Since 1985, more than 400 new cases of childhood lead poisoning were diagnosed in Paris, France. The resurgence of lead poisoning is a major public health concern.1,2The treatment of these children with increased blood lead levels was consistent with the guidelines of the Centers for Disease Control and Prevention (CDC), Atlanta, Ga,2-4which recommend a lead mobilization test for patients with intermediate lead intoxication to determine which children would benefit from chelation therapy. However, performing 24-hour provocative tests in young children has proved difficult: urine collection is often incomplete, and hospitalization is often necessary. The aim of our study was to decrease the urinary collection period of provocative tests to 5 hours and to assess the validity of this shortened procedure. Patients and Methods.During a 17-month period between May 1989 and October 1990, 34 edetate calcium disodium (CaNa2EDTA) mobilization tests were attempted in 32

One hundred and twenty nine children with chronic lead poisoning were followed from August 1985 to July 1989. Old lead paint was recognized as the contaminant source at home. Pica of paint flakes was the main mode of intoxication. Children were classified according to the Center for Disease Control 1985 as follows: class IV (39 cases), class III (45 cases), class II (30 cases), class I (15 cases). Nineteen of those in class IV had blood lead levels above 700 micrograms/l and received BAL + EDTA followed by EDTA alone for a mean of 4.6 +/- 3.5 courses. With this treatment, blood lead level decreases were 50 +/- 17%. Nine of these class IV children had an evaluation at last 3 months after the last chelation course: 5 became class I or II, and 2 class III with a negative provocative test. The remaining 20 children in class IV were given a mean of 2.7 +/- 1.4 courses of EDTA. Blood lead levels decreased by 52 +/- 15%; 11 children were evaluable at least 3 months after the last chelation course: 4 became class I, and 7 class II. Thus overall 80% of class IV moved under treatment to class I or II. Among those 45 children in class II, 30 underwent a provocative test and 24 one to three courses of EDTA: 8 were further studied: 3 became class I and 5 class II. Combination of screening, medical treatment and sociocultural approach led to avoid acute effects of severe chronic childhood lead poisoning. The efficacy of such an approach in preventing chronic effects has still to be evaluated.