A Hyperpigmented Reticular Rash in a Patient on Peritoneal Dialysis

Pediatric erythema ab igne: clinical aspects and diagnostic issues

Erythema ab igne is a dermatological condition resulting from repeated low-grade heat exposure (below the burning point), which can variably manifest with reticulated erythema and skin hyperpigmentation. Not infrequently, the cause of such a skin disorder is not immediately evident or reported by patients, especially if these are children. Compared to adults, erythema ab igne is rare in children and, if the general practitioners and pediatricians are not aware of this disorder, pediatric patients are often addressed to rheumatologists and/or undergo useless immunological investigations. Here, we performed a systematic case-based review, which finally included 32 cases of pediatric erythema ab igne (in addition to our new clinical report), and discussed the main clinical aspects and issues of this clinical entity in children. In detail, similarities of erythema ab igne with livedo reticularis and/or vasculitis-related rashes sometimes can lead to perform a panel of immunological investigations, which could be avoided. Indeed, our analysis emphasizes the importance of a careful and complete patient's anamnesis, including active questioning about the potential exposure to any physical agents (including heat sources) that may cause dermatological lesions. We also highlight some peculiarities in terms of location and heat injury in children developing erythema ab igne, based on the presence or absence of comorbidities.

CONCLUSION

The occurrence of erythema ab igne in children (and especially in adolescents) is likely to increase in the next years because of the greater and sometimes inappropriate use of technological devices. Physicians should be aware of this condition in order to prevent patients from useless investigations, especially in the differential diagnosis of rheumatic disorders. A careful and complete patient's history with active questioning about the potential exposure to heating source is often decisive to diagnose erythema ab igne.

WHAT IS KNOWN

• Erythema ab igne is a dermatological condition which is mainly described in adults exposed to heating source at the workplace.

WHAT IS NEW

• The occurrence of erythema ab igne in children is likely to increase in the next years because of the greater and sometimes inappropriate use of technological devices. • Erythema ab igne in children can be classified in two main categories, based on the presence or absence of comorbidity. • A careful and complete anamnesis (including the active questioning about potential exposure to any heating source) is the mainstay for diagnosing erythema ab igne in children.

Primary renal diffuse large B-Cell lymphoma causing haemodialysis-dependent nephromegaly in a child

A 4-year-old boy presented with fatigue and was found to have severe kidney injury requiring haemodialysis. A renal ultrasound demonstrated bilateral nephromegaly with mild loss of corticomedullary differentiation but preserved echogenicity. He had a persistent isolated monocytosis. Renal biopsy revealed extensive infiltration by primary renal diffuse large B-cell lymphoma. He required haemodialysis for 18 days and received chemotherapy with cyclophosphamide, doxorubicin, vincristine, prednisone, rituximab and intrathecal methotrexate. He achieved remission with an estimated glomerular filtration rate of 50 mL/min/1.73 m², and his kidneys returned to normal size. Nephromegaly due to renal-limited haematolymphoid disease is extremely rare, especially in children.