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Background Although more common in older adults, stroke also occurs in neonates, infants, children, and young adults, resulting in significant morbidity and mortality Aim: The description and differential diagnosis of a 13-year-old female adolescent with haemorrhagic stroke and a personal history of diabetes mellitus type 1, hyperlipidemia under ezetimibe. The general paediatrician should be informed that stokes occur in children, although in a lower percentage than adults. Result 13-year-old adolescent was brought to the emergency department because of hypoglycemia ( GLC: 50mcg/dl at home), headache, dysarthria and vomiting ( 3 times) the last 3 hours. Personal history: diabetes mellitus type 1(insulin-dependent) and hyperlipidemia under treatment with ezetimibe. She was admitted to the department of Paediatrics, BP: 115/75 mmHg, blood tests showed high leucocyte levels (18.000) with polymorphonuclear leucocyte type ( 80%), because of vomiting, CRP and ESR were not elevated. Glucose blood levels were restored with no signs of improvement. Because of a headache, she had a paranasal x-ray. As the time was going by, the patient became intoxicated with worsening dysarthria. Because of lack of executive personnel in our hospital, she was transferred to the tertiary hospital with GCS: 13/15. A computed tomography was conducted that showed a wide haemorrhage on the right temporoparietal lobe with 3,5 cm diameter, surrounded by oedema that shifted the midline structure to the left for 4,5 cm. The spinal basal system and Willis circle were intact. She was treated with mannitol, anti-seizure drugs and painkillers. One week later, an MRI was conducted that showed the haemorrhage with the same size of surrounding oedema. The antiedematous drugs were sustained for several days, the clinical appearance of the teenager was improved. Conclusion This case report signifies a) the incidence of strokes in children, although it is in low percentage, so that general paediatricians are alerted about these cases, b) the lack of executive personnel and technical materials in greek hospitals due to the financial crisis of the recent years and the consequences of this situation on patient outcome.

Background Although more common in older adults, stroke also occurs in neonates, infants, children, and young adults, resulting in significant morbidity and mortality Aim The description and differential diagnosis of a 13-year-old female adolescent with haemorrhagic stroke and a personal history of diabetes mellitus type 1, hyperlipidemia under ezetimibe. The general paediatrician should be informed that stokes occur in children, although in a lower percentage than adults. Result 13-year-old adolescent was brought to the emergency department because of hypoglycemia ( GLC: 50mcg/dl at home), headache, dysarthria and vomiting ( 3 times) the last 3 hours. Personal history: diabetes mellitus type 1(insulin-dependent) and hyperlipidemia under treatment with ezetimibe. She was admitted to the department of Paediatrics, BP: 115/75 mmHg, blood tests showed high leucocyte levels (18.000) with polymorphonuclear leucocyte type ( 80%), because of vomiting, CRP and ESR were not elevated. Glucose blood levels were restored with no signs of improvement. Because of a headache, she had a paranasal x-ray. As the time was going by, the patient became intoxicated with worsening dysarthria. Because of lack of executive personnel in our hospital, she was transferred to the tertiary hospital with GCS: 13/15. A computed tomography was conducted that showed a wide haemorrhage on the right temporoparietal lobe with 3,5 cm diameter, surrounded by oedema that shifted the midline structure to the left for 4,5 cm. The spinal basal system and Willis circle were intact. She was treated with mannitol, anti-seizure drugs and painkillers. One week later, an MRI was conducted that showed the haemorrhage with the same size of surrounding oedema. The antiedematous drugs were sustained for several days, the clinical appearance of the teenager was improved. Conclusion This case report signifies a) the incidence of strokes in children, although it is in low percentage, so that general paediatricians are alerted about these cases, b) the lack of executive personnel and technical materials in greek hospitals due to the financial crisis of the recent years and the consequences of this situation on patient outcome

Introduction Neonatal jaundice is one of the most frequent diagnostic and therapeutic problems. It is estimated that 60% of term neonates and 80% of premature neonates present jaundice in their first week of life. Often, everyday measurements of bilirubin are needed, for early diagnosis and treatment. There are three methods of bilirubin measurement: the serum bilirubin measurement, the capillary and the transcutaneoust. Transcutaneous method is referred to be reliable related to other invasive methods of measurement, at least for low bilirubin prices. Aim The comparison of measurement results of non-invasive transcutaneous method with capillary plasma bilirubin method. Methods All the bilirubin measurements during the time period from 25/01/2016 to 18/02/2016 in the neonates of our Clinic. Results There were 59 bilirubin measurements in 49 newborns. At first, the capillary method was used and then the transcutaneous. The statistical analysis showed that the two methods have normal distribution. The capillary method highlighted a price range of 3,90 mg/dl- 13,20 mg/dl (SD=2,03) and the transcutaneous method showed a range from 4,3 mg/dl to 15,5 mg/dl (SD=2,45). The Pearson Correlation coefficcient of the two methods was 0,903, showing a positive significant correlation (p Conclusion Transcutaneous method can replace the capillary method, in order to have an everyday, non- invasive method of bilirubin measurement. However, in bilirubin prices>15 mg/dl, or when a therapeutic intervention is needed, the laboratory measurement is necessary.

Background Sixty-five percent of newborns develop visible jaundice with a total serum bilirubin level higher than 6 mg/dl, during the first week of life. Causes of pathologic unconjugated hyperbilirubinemia are those, who engender hemolysis (ABO blood group and Rh incompatibility, G6PD deficiency), neonatal jaundice (NJ) as a result of neonatal infection and breast feeding associated jaundice. Treatment of indirect hyperbilirubinemia is phototherapy, exchange transfusion and antibiotics (if needed). Aim The recording/investigation of the frequency of cases of infants with NJ, hospitalised in Neonatal Department (ND) of our hospital (1/1/2015- 31/12/2016), the correlation with demographic and other factors (sex, gestational age (GA), birth weight (BW)) and the discussion of the results. Method/Material We were based on data, that were obtained by printed and online file of ’ASCLEPIUS’ (Hospital’s online patient file). There were included incidents of NJ, introduced in the Paediatric‘s clinic ND, of our hospital, came from the Hospital’s Obstetrical Clinic (O/C), Private O/C or from home. For the definition of the pathological values of jaundice, we used the tables of Greek Neonatal Society (2012). Results In total of 58 cases NJ {28 (2015), 30 (2016)}, the 40 were males (69%). They were categorised by the GA in near-term (35–37 w), full-term (>38w) and premature ( 3000 gr, while the percentage, based on the day of life, where hyperbilirubinemia occured, ranged as follows: 1 st day of life: 6.9%, 2nd day: 12%, 3rd day : 31%,>4 th day: 50%. In 1/3 of cases (∼36%) the cause of NJ was not clarified, while 24% was attributed to ABO group incompatibility and∼14% to perinatal infection (early-onset form: 87.5%). In the percentage of∼26% of NJ, were included more than one risk-factors. They treated with fototherapy (single and/or double), lasting 5–50 hours, good hydration and appropriate antibiotic treatment (in cases of infection). Two newborns were transferred to a Neonatal Intensive Care Unit, of the Tertiary Hospital in Thessaly, for further investigation/treatment. Conclusions NJ usually constitutes a normal clinical manifestation, but it needs monitoring, as it may, sometimes, be an indicator of some pathological conditions (NJ at the first day of life in most cases conceals neonatal infection). In contrast 48% of hyperbilirubinemia’s cases in the second and third day of life, participate as pathological agents, the above causes of hemolytic jaundice.

Background Myofasciitis is a rare disease of the muscles and its fascia, which is most common in adults and is very rarely found in children. Aim Description of a case of myositis-peritonitis(fasciitis) in a 4 year old female toddler and arise the awareness of the hospital and general paediatrician for the clinical presentation of this rare disease. Method-material-case description In November of 2016 a 4 year old toddler of greek origin from the state of Magnesia, Greece, was admitted to the emergency department of our hospital. The toddler presented claudication 12 hours prior to the admission and symptoms of upper and lower respiratory tract infection with cough from several days. At the admission the toddler presented claudication, limitation of the active and passive motility of both hips, especially the right, limited motility of the truncus and limbs, swelling of right cheek and right temple. Imaging studies revealed swelling of the soft tissues around the right hip joint and swelling of multiple intra-parotid and neck lymph nodes. The blood examination at the admission revealed leukocytosis, mild increase of the indicators of inflammation, of creatine phosphokinase (CPK) and increased coagulation time. Because of the clinical picture of the patient intravenous antibiotics were givenB(ceftriaxone and clindamycin).The differential diagnosis included myositis, fasciitis, septic arthritis of right hip joint and invasive general microbe infection. Results Because of the rapid deterioration of the clinical and laboratory picture in the next 12 hours (further increase of CPK, indicators of inflammation) the toddler was transferred to a tertiary Hospital of Athens. The imaging studies revealed a consolidation of the basis of the right lung and mild consolidation behind the heart. The MRI revealed swelling and inflammation of the majority of the muscles of the haunches, the thighs (especially the right), swelling of the subcutaneous tissue of both haunches and its fascias. The clinical and imaging picture was compatible with myofasciitis. The general status of the patient was improved and the antibiotic therapy was continued for 14 days in total. The metabolic and rheumatologic results are still pending. Conclusions The data in literature for myofasiitis are not enough but we believe that it is localised histological inflammation that may be caused by a previous immunisation with alluminium adjuvants contained vaccines, rather than a primary inflammatory muscle disease. The histological hallmark of myofasciitis is the infiltration of the muscle and its fascia by macrophage cells. The symptoms include joint pain, muscle weakness, fatigue, fever and pain on the palpation of the muscles.

Introduction Neonatal jaundice is one of the most frequent diagnostic and therapeutic problems. It is estimated that 60% of term neonates and 80% of premature neonates present jaundice in their first week of life. Often, everyday measurements of bilirubin are needed, for early diagnosis and treatment. There are three methods of bilirubin measurement: the serum bilirubin measurement, the capillary and the transcutaneoust. Transcutaneous method is referred to be reliable related to other invasive methods of measurement, at least for low bilirubin prices. Aim The comparison of measurement results of non-invasive transcutaneous method with capillary plasma bilirubin method. Methods All the bilirubin measurements during the time period from 25/01/2016 to 18/02/2016 in the neonates of our Clinic. Results There were 59 bilirubin measurements in 49 newborns. At first, the capillary method was used and then the transcutaneous. The statistical analysis showed that the two methods have normal distribution. The capillary method highlighted a price range of 3,90 mg/dl- 13,20 mg/dl (SD=2,03) and the transcutaneous method showed a range from 4,3 mg/dl to 15,5 mg/dl (SD=2,45). The Pearson Correlation coefficcient of the two methods was 0,903, showing a positive significant correlation (p Conclusion Transcutaneous method can replace the capillary method, in order to have an everyday, non- invasive method of bilirubin measurement. However, in bilirubin prices>15 mg/dl, or when a therapeutic intervention is needed, the laboratory measurement is necessary.

Bckground Hemophagocytic syndrome (HS) is an hyperinflammatory syndrome caused by severe hypercytokinemia with excessive activation of macrophages and lymphocytes. HS can be primary, or secondary, as a response to infection, malignacy or autoimmune disease. Aim The description of a case of HS as the first manifection of systemic lupus erythematosus diagnosed at our paediatric department. and arise the awareness of the hospital and general paediatrician for the clinical and laboratory presentation of this rare disease. Method A nine year girl was admitted, due to fever and fatigue. During her hospitalisation, she developed anaemia and leukocytopenia, elevated liver enzymes and renal function worsening (Urea: 59 mg/dl, microscopic hematuria, albuminuria). Prolonged fever, splenomegaly, bicytopenia, hyperferritinemia (Fer: 38 450 ng/ml) and hypertriglyceridemia (TRGs: 468 mg/dl) put the suspicion of HS diagnosis. Immunology tests revealed the presence of positive anti-nuclear antibodies and low C3 and C4 levels. She was transferred to a tetriary paediatric hospital for further investigation and treatment. Results At the tertiary paediatric hospital, secondary hemophagocytic syndrome was confirmed -hemophagocytosis was found at a bone marrow puncture-biopsy that was performed- and Systemic Lupus Erythematosus proved to be the primary cause. The duration of hospitalisation was 15 days, and the treatment included methylprednisone, ivig, hydroxychlroroquine and cyclophosphamide. Conclusion Hemophagocytic syndrome is a rare life threatening entity, that should be taken into concideration when prolonged fever is investigated. Being connected to bad prognosis and risk of permanent tissue damage, prompt diagnosis and treatment are required.

Introduction Juvenile Idiopathic Arthritis is a chronic inflammatory disease associated with arthritis of unknown origin that appers before the age of 16 and persists for more than 6 weeks. It is the most common rheumatic disease in children and is characterised by eterogeneity. Purpose The description of three cases of JIA diagnosed at our paediatric department, according to demographic and other factors. Method The first case refers to a 2 year old young girl admitted to our department due to prolonged fever and lameness. The laboratory tests revealed elevates ECR levels. As far as the other two patients are concerned, they were boys, 4 and 7 years old respectively, that were both admitted due to joint pain and lameness. The laboratory tests revealed elevates ECR levels, but the articular punctures were not diagnostic. Results Specific immunology tests were performed to all the patients. Positive ANA and anti-dsDNA Ab were found at the girl. Eye examination revealed iridocyclitis, while ultrasound showed synovitis. JIA was confirmed and treatment started with methotrexate. MRI was performed to both boys, that revealed significant ammount of fluid at the affected joint. JIA was an on exclusion diagnosis and treatment included per os corticosteroids and methotrexate. Conclusion JIA is an entity that should be taken into concideration when monoathritis, lameness or prolonged fever is investigated. Being connected to bony deformity and growth retardation, prompt diagnosis and treatment are of great value.

Background Diabetes Mellitus (DM) involves a variety of metabolic disorders, caused by ‘hyperglycemia’ (secretion insufficiency or reduced insulin activity). Diabetes Mellitus type 1 (absolute insulin quantitative deficiency) is one of the four DM types. DM type 1a is autoimmune (most common) and DM type 1b is idiopathic. Aim Epidemiological recording of hospitalised children suffering from DM type 1 (2012–2016) based on demographic and other characteristics (age, sex, residence, duration of hospitalisation, body weight, HbA1c levels, first-diagnosis or deregulation, presence or no of hereditary background, presence or no of diabetic acidosis). Method/Material 31 children suffering from DM type 1 have been hospitalised in our clinic through the past five years. Cause of hospitalisation was either the disease itself or its complications (diabetic acidosis, hypoglycemia, deregulation) and more rarely another disease, usually infectious. The reference data and correlates were: sex (boys/girls), age (toddlers/preschoolers/school-age children/adolescents), residence (Volos, rest of Magnesia region, Pelion, Sporades), year of hospitalisation, body weight (over or under 50th percentile), HbA1c levels, duration of hospitalisation and presence or no of DM type 1 or 2 hereditary background. Results 31 children have been recorded (17 boys). Sorted by age groups: 19 school-age children (6–12 y.o.), 6 adolescents (>13 y.o.), 3 preschoolers (3–5 y.o.) and 3 toddlers (1–3 y.o.). Sorted by year of hospitalisation: (2012–2016) (2,9,6,7,7 respectively). Most of them were residents of Volos and Pelion. Hospitalisation lasted 1–14 days (average: 5 days). HbA1c levels have been recorded in 25 children, 12 of whom HbA1c was over 10. 24 out of the 31 children were first diagnosed with DM type 1 (10 of whom presented with diabetic acidosis) and 7 of them presented with deregulation. In 10 children hereditary background of DM type 1 or 2 was revealed. Conclusions Based on the recordings, boys are more frequently affected (in contrast with recent epidemiological findings). The often affected age group is once more proved to be school-age children (6–12 y.o.). The highest number of hospitalised children is noted in 2013 and the number of Pelion and Sporades diabetic children is higher compared to these areas’ total populations (but our sample is small, for general results). HbA1c levels are indicative of glycemic control through the past 3 months, a fact which proves that the disease creeps weeks before being diagnosed. Aproximately 1/3 of the children have first-degree relatives suffering from DM type 1 or 2, a fact which evinces the role of heredity in DM’s type 1 pathogenesis.

Background and aims Neonatal infections (NI) among newborn during the neonatal period, may be contracted by transplacental transfer in utero, in the birth canal during delivery (perinatal), or by other means after birth. It is a retrospective recording of early and late NI of neonates hospitalised in pre-NICU during 2015–2016. Methods Recording of the cases of NI according to the ICD-10 system and excel editing. Results 118 cases of NI have been collected, 61 (2015), 57 (2016), 38 females (33, 3%) and 80 males (67, 7%), in total. The neonates were referred from the OBGyn Department of Achillopouleio General Hospital(61,8%), the delivery room of the same hospital(24,5%), OBGyn Department of private hospitals(5,9%), paediatric private practice(6,7%) and 1 baby was born on board. 47,5%(56) had normal-labour and 52, 5%(62) cesarian-section. The amniotic fluid was dirty in 16%(19) and clear in 84% (99). The day of admission in the hospital was on the 1st, 2nd, 3rd and >4th day of life( 57%(67), 21%(25), 4%(5), 7%(8) and 11%(13), respectively). Blood cultures were done on all the babies on admission (positive with S. Epidermidis(0,85%). Other body fluid cultures included: Urine culture (22,8%), culture of faeces(1,69%), and orbital fluid(1,69%) with negative results. 11% (13) had lumbar puncture (0,84% positive for S. saprophyticus). 32,2%(38) neonates with TORCH investigation( 0,84% was positive for HSV). The clinical features on admission were lethargy 8,47%(10), feeding problems 16,9%(20), vomiting 9,3%(11), grunting 14,4%(17), tremor 3,38%(4), jaundice 16,9%(20), respiratory distress 9,3%(11), pallor 22%(26), apnea 13,5%(16), bloody faeces 0,85%(1), bradycardia 2,5%(3), hypoglycemia 0,85%(1), acrocyanosis 3,38%(4) and skin problems 2,5%(3). Lab results showed elevated CRP (>10):42,3% (50) and elevated WBC (>20000):31,3%(37), respectively. The drug treatment provided was: Ampicilline-Amicacine for 3 days (11,4%), 5 days(43,2%) and the rest different duration and combination of drug treatment. Conclusion The Department of Paediatrics personnel treated successfully the cases of NI, despite the absence of a neonatologist. Only 3 cases per year needed reference to tertiary hospital for further management. The admission criteria followed NICE guidelines.

Background and aims Neonatal infections (NI) among newborn during the neonatal period, may be contracted by transplacental transfer in utero, in the birth canal during delivery (perinatal), or by other means after birth. It is a retrospective recording of early and late NI of neonates hospitalised in pre-NICU during 2015–2016. Methods Recording of the cases of NI according to the ICD-10 system and excel editing. Results 118 cases of NI have been collected, 61 (2015), 57 (2016), 38 females (33, 3%) and 80 males (67, 7%), in total. The neonates were referred from the OBGyn Department of Achillopouleio General Hospital(61,8%), the delivery room of the same hospital(24,5%), OBGyn Department of private hospitals(5,9%), paediatric private practice(6,7%) and 1 baby was born on board. 47,5%(56) had normal-labour and 52, 5%(62) cesarian-section. The amniotic fluid was dirty in 16%(19) and clear in 84% (99). The day of admission in the hospital was on the 1 st , 2 nd , 3 rd and >4 th day of life( 57%(67), 21%(25), 4%(5), 7%(8) and 11%(13), respectively). Blood cultures were done on all the babies on admission (positive with S. Epidermidis(0,85%). Other body fluid cultures included: Urine culture (22,8%), culture of faeces(1,69%), and orbital fluid(1,69%) with negative results. 11% (13) had lumbar puncture (0,84% positive for S. saprophyticus). 32,2%(38) neonates with TORCH investigation( 0,84% was positive for HSV). The clinical features on admission were lethargy 8,47%(10), feeding problems 16,9%(20), vomiting 9,3%(11), grunting 14,4%(17), tremor 3,38%(4), jaundice 16,9%(20), respiratory distress 9,3%(11), pallor 22%(26), apnea 13,5%(16), bloody faeces 0,85%(1), bradycardia 2,5%(3), hypoglycemia 0,85%(1), acrocyanosis 3,38%(4) and skin problems 2,5%(3). Lab results showed elevated CRP (>10):42,3% (50) and elevated WBC (>20000):31,3%(37), respectively. The drug treatment provided was: Ampicilline-Amicacine for 3 days (11,4%), 5 days(43,2%) and the rest different duration and combination of drug treatment. Conclusion The Department of Paediatrics personnel treated successfully the cases of NI, despite the absence of a neonatologist. Only 3 cases per year needed reference to tertiary hospital for further management. The admission criteria followed NICE guidelines.

Background Juvenile Idiopathic Arthritis is a chronic inflammatory disease associated with arthritis of unknown origin that appers before the age of 16 and persists for more than 6 weeks. It is the most common rheumatic disease in children and is characterised by eterogeneity. Purpose The description of three cases of JIA diagnosed at our paediatric department, according to demographic and other factors. Method The first case refers to a 2 year old young girl admitted to our department due to prolonged fever and lameness. The laboratory tests revealed elevates ECR levels. As far as the other two patients are concerned, they were boys, 4 and 7 years old respectively, that were both admitted due to joint pain and lameness. The laboratory tests revealed elevates ECR levels, but the articular punctures were not diagnostic. Results Specific immunology tests were performed to all the patients. Positive ANA and anti-dsDNA Ab were found at the girl. Eye examination revealed iridocyclitis, while ultrasound showed synovitis. JIA was confirmed and treatment started with methotrexate. MRI was performed to both boys, that revealed significant ammount of fluid at the affected joint. JIA was an on exclusion diagnosis and treatment included per os corticosteroids and methotrexate. Conclusion JIA is an entity that should be taken into concideration when monoathritis, lameness or prolonged fever is investigated. Being connected to bony deformity and growth retardation, prompt diagnosis and treatment are of great value.

Background Hemophagocytic syndrome (HS) is an hyperinflammatory syndrome caused by severe hypercytokinemia with excessive activation of macrophages and lymphocytes. HS can be primary, or secondary, as a response to infection, malignacy or autoimmune disease. Aim The description of a case of HS as the first manifection of systemic lupus erythematosus diagnosed at our paediatric department. and arise the awareness of the hospital and general paediatrician for the clinical and laboratory presentation of this rare disease. Method/material A nine year girl was admitted, due to fever and fatigue. During her hospitalisation, she developed anaemia and leukocytopenia, elevated liver enzymes and renal function worsening (Urea: 59 mg/dl, microscopic hematuria, albuminuria). Prolonged fever, splenomegaly, bicytopenia, hyperferritinemia (Fer: 38 450 ng/ml) and hypertriglyceridemia (TRGs: 468 mg/dl) put the suspicion of HS diagnosis. Immunology tests revealed the presence of positive anti-nuclear antibodies and low C3 and C4 levels. She was transferred to a tetriary paediatric hospital for further investigation and treatment. Results At the tertiary paediatric hospital, secondary hemophagocytic syndrome was confirmed -hemophagocytosis was found at a bone marrow puncture-biopsy that was performed- and Systemic Lupus Erythematosus proved to be the primary cause. The duration of hospitalisation was 15 days, and the treatment included methylprednisone, ivig, hydroxychlroroquine and cyclophosphamide. Conclusion Hemophagocytic syndrome is a rare life threatening entity, that should be taken into concideration when prolonged fever is investigated. Being connected to bad prognosis and risk of permanent tissue damage, prompt diagnosis and treatment are required.

Introduction Neutropenia is the decrease of neutrophil count in the blood. It is classified as mild, when the Absolute Neutrophil Count (ANC) is 1000–1500 cells/µL, or Aim Incidence and causes of neutropenia in hospitalised children in our Paediatric Clinic during the year 2016. Methods All the hospitalised children from 01-01-2016 to 31-12-2016 were screened for the presence of neutropenia during their hospitalisation. The type of neutropenia, the causes and the other blood cells counts were recorded for every neutropenic child. Results Among 784 children hospitalised during 2016, 35 were found to be neutropenic (4,46%). None of these children had known neutropenia in their history. Viral infections were the first cause of neutropenia, with the second cause (14%) being the use of antimicrobial drugs. The majority of neutropenias were mild to moderate (83%), whereas 6 children presented with severe neutropenia. Among them, three patients were diagnosed with viral infections, two had autoimmune diseases and the other remained undiagnosed. A percentage of 8,5% had also reduction in other blood cells. Conclusion The most common form of neutropenia in hospitalised children is mild-moderate neutropenia of viral aetiology, which resolves itself. However, major systematic diseases should always be excluded.

Background Myofasciitis is a rare disease of the muscles and its fascia, which is most common in adults and is very rarely found in children. Aim Description of a case of myositis-peritonitis(fasciitis) in a 4 year old female toddler and arise the awareness of the hospital and general paediatrician for the clinical presentation of this rare disease. Method-material-case description In November of 2016 a 4 year old toddler of greek origin from the state of Magnesia, Greece, was admitted to the emergency department of our hospital. The toddler presented claudication 12 hours prior to the admission and symptoms of upper and lower respiratory tract infection with cough from several days. At the admission the toddler presented claudication, limitation of the active and passive motility of both hips, especially the right, limited motility of the truncus and limbs, swelling of right cheek and right temple. Imaging studies revealed swelling of the soft tissues around the right hip joint and swelling of multiple intra-parotid and neck lymph nodes. The blood examination at the admission revealed leukocytosis, mild increase of the indicators of inflammation, of creatine phosphokinase (CPK) and increased coagulation time. Because of the clinical picture of the patient intravenous antibiotics were givenB(ceftriaxone and clindamycin).The differential diagnosis included myositis, fasciitis, septic arthritis of right hip joint and invasive general microbe infection. Results Because of the rapid deterioration of the clinical and laboratory picture in the next 12 hours (further increase of CPK, indicators of inflammation) the toddler was transferred to a tertiary Hospital of Athens. The imaging studies revealed a consolidation of the basis of the right lung and mild consolidation behind the heart. The MRI revealed swelling and inflammation of the majority of the muscles of the haunches, the thighs (especially the right), swelling of the subcutaneous tissue of both haunches and its fascias. The clinical and imaging picture was compatible with myofasciitis. The general status of the patient was improved and the antibiotic therapy was continued for 14 days in total. The metabolic and rheumatologic results are still pending. Conclusions The data in literature for myofasiitis are not enough but we believe that it is localised histological inflammation that may be caused by a previous immunisation with alluminium adjuvants contained vaccines, rather than a primary inflammatory muscle disease. The histological hallmark of myofasciitis is the infiltration of the muscle and its fascia by macrophage cells. The symptoms include joint pain, muscle weakness, fatigue, fever and pain on the palpation of the muscles.