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Pyoderma gangrenosum (PG) is a rare neutrophilic dermatosis, characterized by unknown aetiology and sterile neutrophilic infiltrate on histological examination, clinically showing recurrent skin ulcers and mostly affecting lower limbs areas. In 2/3 of the cases, PG is secondary to another disorder such as inflammatory bowel and lymphoproliferative diseases, infections, rheumatic diseases and auto-inflammatory syndromes. The paper describes the cases of three paediatric patients showing the association of PG with rheumatic conditions such as Behçet’s disease, chronic recurrent multifocal osteomyelitis (CRMO) and PAPA (Pyogenic Arthritis, Pyoderma gangrenosum and Acne) syndrome and proposes a diagnostic flow-chart to help paediatricians recognize PG and associated conditions.

Crusted scabies (CS) is a severe form of scabies caused by hyper-infestation of mites in the horny layer of the epidermis that thickens and forms warty crusts.1 Although it has been described mainly in immunosuppressed individuals, it has been also observed in otherwise healthy patients.1 We are living the coronavirus disease 2019 (COVID-19) outbreak, that is a mild/moderate disease in children.2-4 However, SARS-CoV-2 infection may induce significant changes in the host's immune response.5,6.

Summary Introduction Bladder ultrasound is becoming pivotal in the management and treatment of lower urinary tract dysfunction. There is a paucity of data regarding intra-observer and interobserver reliability of bladder ultrasound, especially in children. A previous study assessed interobserver agreement for both the postvoid residual volume and measurement of the bladder dimensions in adults showing excellent agreement. Objective To examine the interobserver and intra-observer reliability of bladder wall thickness, bladder urinary and postvoid residual urinary volume using ultrasound evaluated by paediatricians having different training levels. Study design Four sonographers, 3 pediatric trainees and one experienced pediatric urologist measured the full bladder volume, the voiding residual volume, and the bladder wall thickness. Each sonographer made 3 measurements of each parameter. We assessed the interobserver and intra-observer variability by using intraclass correlations (ICCs). ICCs were calculated and tested with a significance level of 5%. The interrater ICC was calculated from the mean of the three measurements of each variable (full bladder volume, postvoid residual, bladder wall thickness). ICC ≥0.75 was considered excellent. Bland-Altman plots were also used to assess the interobserver agreement. Results Sixty children were recruited (7.3 ± 1.1 years). The interobserver ICCs for bladder volume and voiding residual volume were 0.91 (confidence interval 0.85–0.95) for both. The interobserver ICCs for the bladder wall thickness was satisfactory 0.43, with a minimum detectable difference of 2 mm. The observed values for intra-observer analysis showed an excellent (ICC ≥ 0.90) agreement between the three measurements performed by each one of the sonographers. Bland-Altman plots showed that the bias (mean difference) was −0.35 and the limits of agreement were −3.43 and 2.73 for the bladder wall thickness measurements (Figure). Discussion The interobserver reliability for both the postvoid residual volume and full bladder volume were excellent even in operators with different levels of training, pointing out the role of bladder ultrasound in the routine clinical practice. Weaker agreement was found for the bladder wall thickness measurement. The intra-observer agreement was excellent for all the measurements. Conclusion These results showed a good reliability of urinary bladder ultrasound in children aged 7.3 ± 1.1 years as far as bladder volume measurement is concerned. Given the variability of bladder wall thickness, a standardized methodology is desirable to increase its reliability.