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nfant Kawasaki DiseaseBackgroundKawasaki disease (KD) is an acute systemic vasculitis. Young infants represent a high risk population.Case Presentation SummaryWe report two geographically and temporally unrelated cases of neonatal KD; two 6 week-old male infants presented with fever, irritability, tachycardia, sterile pyuria, high inflammatory markers and CSF pleocytosis. Each received antibacterial and antiviral cover for suspected meningitis. The microbiologic investigations of infant 1 remained negative. He developed widespread erythematous pleomorphic rash and unilateral cervical lymphadenopathy day 2, conjunctival injection and red lips, Day 3/4. KD was suspected on day 4 of fever. He was treated with intravenous immunoglobulin (IVIG), aspirin, methylprednisolone and cyclosporine. His echocardiography showed progressive coronary artery dilation and valvulitis which stabilized and regressed in response to therapy. He is clinically well at follow up.Infant 2 tested positive for RSV, had Gram positive cocci later identified as Staphylococcus epidermidis in blood culture and E. coli in his urine. KD wasnu2019t suspected until day 12 of fever, having developed periungual desquamation. He received IVIG, methylprednisolone, aspirin and cyclosporine but developed large LAD aneurysm, complicated by thrombus requiring ongoing anticoagulation.Learning Points/DiscussionInfants under 3-months of age account for less than 2% of KD cases and represent a high risk population with up to 35% developing coronary artery abnormalities. The symptoms are frequently incomplete, fever more likely attributed to bacterial or viral sepsis and diagnosis delayed. Our 2 patients, of similar ages and presentation, who received similar treatment albeit at different time points in their illness experienced different outcomes. This underscores the need for early suspicion of KD and an aggressive approach to anti-inflammatory therapies. KD should be considered in any infant with persistent fever and rising inflammatory markers despite seemingly appropriate treatment.

Herpes Zoster Encephalitis in an Immunocompetent 8 year-old GirlBackgroundVaricella Zoster virus (VZV) may be associated with neurologic complications in children, such as febrile convulsions, encephalitis, stroke or sinus thrombosis. Herpes Zoster (HZ) is a reactivation of VZV in a person with previous acute VZV infection or vaccinated with life attenuated vaccine. While in adults, HZ encephalitis is a recognised complication, it is rarely described in children.Case Presentation SummaryWe present a case of a VZV immune 8-year-old girl with a painful vesicular skin eruption in a C2-C4 distribution, progressive hemiplegia and hemi-sensory syndrome. CT showed an area of hypodensity in the contralateral thalamus. CSF analysis revealed a high lymphocyte count and MRI of brain and spine demostrated multiple lesions of T2 hyperintensity. She was treated with high dose acyclovir, steroids and intravenous immunoglobulin. She received intense physio- and occupational therapy. Within 2 weeks of initial presentation, she has regained over 75% of her function.In view of the rash with a typical dermatomal distribution, multifocal MRI findings and time relationship between the rash and onset of neurologic signs, she was diagnosed with HZ encephalitis. CSF PCR testing for zoster was negative.Learning Points/DiscussionIn jurisdictions with universal varicella vaccination, decrease in the incidence of acute CNS complications in children is reported. However, mass introduction of VZV vaccine remains controversial, because of feared increase of the age and severity of primary varicella and of the incidence of Herpes Zoster. This is a rare presentation of HZ encephalitis in an immunocompetent child with a documented episode of primary varicella during infancy. We reviewed literature available on CNS complications of Herpes Zoster, their risk factors, diagnosis, management and outcomes in immunocompetent vaccinated and unvaccinated children.