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THE JOURNAL OF THE JAPAN PEDIATRIC SOCIETY
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Vol.129, No.9, September 2025
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Review
Title
The Clinical Characteristics of Acute Suppurative Thyroiditis Complicated by Bacteremia: A Case Report and Literature Review
Author
Chiho Chikazawa Noriko Sato Mihoko Furuichi Yoji Uejima Satoshi Sato and Eisuke Suganuma
Division of Infectious Diseases, Immunology and Allergy, Saitama Children's Medical Center
Abstract
Acute suppurative thyroiditis (AST) is a rare thyroid disease, and pathogens are often transmitted through hypopharyngeal pyriform sinus fistulas (PSF) in Japanese children. Although the thyroid gland has an abundant blood flow, cases of AST complicated by bacteremia have only rarely been reported. An 8-year-old boy was referred to our hospital complaining of fever, neck swelling, and neck pain. Based on the imaging findings, the patient was diagnosed with AST. Despite administering intravenous antimicrobial therapy, his symptoms worsened, and the thyroid abscess increased in size. On the third day of hospitalization, CT revealed a deviated trachea; therefore, urgent abscess drainage was performed. A blood culture was positive for Parvimonas micra, and a pus culture was positive for Parvimonas micra and some other normal oral inhabitants. We concluded that the patient developed secondary bacteremia after the onset of AST. Postoperatively, the patient responded well to antimicrobial therapy and was discharged on Day 20. Two months later, a pharyngoesophagogram revealed PSF, and the patient underwent radical surgery to prevent a recurrence of AST. In previous reports, most bacteremia cases associated with AST were primarily observed in immunocompromised individuals or patients with prior skin or vascular puncture procedures, without any complications of PSF. Secondary bacteremia in immunocompetent patients remains extremely rare. Accurately diagnosing whether a patient has primary bacteremia based on their medical procedure history and laboratory results can help determine the indications to perform a fistula examination.
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Original Article
Title
Safety and Efficacy of Hemangiol® Syrup 0.375% for Pediatric Use in Infantile Hemangioma
Author
Michio Ozeki1) Naoko Baba2) Ryota Kubo3) Daisuke Yoshioka3) Masaki Sanekata3) Tsuyoshi Kani3) Keita Matsui3) and Satoru Sasaki4)
1)Department of Pediatrics, Graduate School of Medicine, Gifu University
2)Department of Dermatology, Kanagawa Children's Medical Center
3)Pharmacovigilance & Post-marketing Surveillance Department, Maruho Co., Ltd.
4)Department of Plastic and Reconstructive Surgery, Center for Vascular Anomalies, Tonan Hospital
Abstract
In this study, we conducted a post-marketing survey on Propranolol (Hemangiol Syrup for Pediatric 0.375%; hereinafter, Hemangiol) over a 76-week observation period to collect information on the long-term safety and efficacy of Hemangiol in patients with infantile hemangioma. In the safety analysis, 354 subjects were included; adverse drug reactions were observed in 55 subjects. Common adverse drug reactions included diarrhea in 8 subjects, hypoglycemia in 7 subjects, asthma in 5 subjects, bradycardia and hypotension in 4 subjects, respectively, and hypoglycemic seizure, wheezing, and hyperkalemia in 3 subjects, respectively. In the efficacy analysis, 339 subjects were included, and 94.5% were assessed as "effective" during the first treatment period. Of these subjects, the treatment was found to be 96.8% effective in those who were 6 months or younger at the start of treatment, compared with a lower efficacy of 55.6% in subjects who were 13 months or older at the start of treatment. A survey questionnaire of parents' satisfaction with the treatment of infantile hemangioma at the start and end of the observation period showed improvement in anxiety and overall satisfaction. The efficacy rate of Hemangiol was high, and so was satisfaction with the treatment. Of the subjects aged 13 months or older under continuous treatment, 4 subjects had serious hypoglycemia with altered consciousness or convulsions. Given that infantile hemangiomas can sometimes resolve naturally, it is crucial to carefully weigh the risks and benefits when considering the continuation of treatment in patients over one year of age.
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Original Article
Title
Impact of Underlying Health Conditions on Clinical Outcomes and Medical Resources Used in Children with COVID-19
Author
Ai Ito-Shinjo1) Kensuke Shoji2) Hiroyuki Iijima1) Tomoo Nakamura1) and Mitsuru Kubota1)
1)Department of General Pediatrics and Interdisciplinary Medicine, National Center for Child Health and Development
2)Division of Infectious Diseases, Department of Medical Subspecialties, National Center for Child Health and Development
Abstract
Objective: To determine the relationship between the presence or absence of underlying disease and the clinical features, as well as healthcare resource utilization, in pediatric admissions for Coronavirus Disease 2019 (COVID-19) during the Omicron variant epidemic.
Methods: We selected test-positive patients under 18 years of age who were admitted to our COVID-19 ward between January and April 2022. We divided the patients into two groups based on the presence or absence of underlying disease. We analyzed the clinical features and healthcare resource utilization between the two groups.
Results: A total of 126 patients were included in the study. Fifty-one had underlying diseases (twenty were children depending on medical technology). We revealed that children with underlying diseases had large incidences of pneumonia, more cases receiving Remdesivir, Sotrovimab, and oxygen therapy, longer hospital stays, and higher medical costs, significantly. We also found that the length of stay of children with underlying diseases (median 9 [quantile 6―11] days) was longer than children without underlying diseases (7 [5―8] days), and the medical costs of children with underlying diseases was higher (616,890 [368,290―982,060] yen) than children without underlying diseases (430,330 [330,680―529,650] yen), significantly (p<0.05). Among children depending on medical technologies, the length of stay was 12 (10―13) days, and the medical costs were 1,065,800 (608,620―1,376,680) yen.
Conclusions: Children with underlying diseases are more likely to develop severe COVID-19, resulting in longer hospitalizations and higher medical costs. This tendency was particularly strong among children who depended on medical technology.
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Brief Report
Title
Comorbidities of Orthostatic Dysregulation and Cerebrospinal Fluid Leak and Pediatric Considerations
Author
Mizuho Hosogi1)2) and Ayumi Okada3)4)
1)Hosogi Children's Clinic
2)Department of Pediatric Psychosomatic Medicine, National Hospital Organization Fukuyama Medical Center
3)Department of Pediatrics, Faculty of Medicine, Dentistry and Pharmaceutical Sciences, Okayama University
4)Department of Child Psychosomatic Medicine, Okayama University Hospital
Abstract
Despite sharing similar phenotypic characteristics, diagnosing cerebrospinal fluid leak (CSFL) or orthostatic dysregulation (OD) can significantly influence clinical progression. This study examined seven pediatric patients who met the diagnostic criteria for both conditions. Initially diagnosed with OD by the pediatrician, all patients were later diagnosed with CSFL by the neurosurgeon and showed improvement or complete resolution following neurosurgical treatment. However, four patients required continued pediatric care for school non-attendance and OD symptoms, despite improvements in secondary OD symptoms attributed to CSFL. Therefore, CSFL should be considered when assessing patients diagnosed with OD, particularly those with a history of injury or those who do not respond to standard OD therapies. Some patients may still require ongoing non-surgical care, such as biopsychosocial support, to address psychosocial factors in addition to CSFL treatment. Thus, collaboration among relevant medical departments is essential for comprehensive patient care.
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