Driscoll Children's Hospital

Cat scratch disease is a zoonotic infection caused by Bartonella henselae and typically presents with regional lymphadenopathy and mild systemic symptoms in immunocompetent children. Atypical disseminated disease with visceral involvement is uncommon and may occur without classic clinical findings, leading to delayed diagnosis, particularly in patients with altered immune responses. We describe the case of an 11-year-old girl with type 1 diabetes mellitus who presented with persistent fever and progressive abdominal pain. Initial evaluation suggested streptococcal pharyngitis, and she was treated with appropriate antibiotics without improvement. Subsequent imaging revealed multiple hepatic lesions concerning for malignancy or infection. The patient had significant cat exposure but lacked lymphadenopathy or cutaneous lesions. Laboratory studies demonstrated anemia and elevated inflammatory markers with normal liver enzymes. Magnetic resonance imaging confirmed multifocal hepatic involvement. Based on imaging findings and exposure history, disseminated Bartonella henselae infection was suspected, and empiric antimicrobial therapy was initiated. The patient improved clinically, and serologic testing later confirmed the diagnosis. This case highlights an atypical presentation of disseminated cat scratch disease with isolated hepatic involvement in a child with diabetes mellitus. Recognition of hepatic lesions on imaging and careful exposure history were critical for diagnosis. Clinicians should maintain a high index of suspicion for Bartonella henselae in pediatric patients with prolonged fever and abdominal pain, especially those with metabolic or immunologic risk factors, even in the absence of classic features.

Background Childhood obesity is a chronic, relapsing disease with significant short- and long-term cardiometabolic, psychosocial, and economic consequences. Over the past decade, advances in clinical research and updated professional guidelines have reshaped the evaluation, prevention, and management of pediatric obesity. Methods This narrative review synthesizes contemporary evidence published between 2016 and 2026, including major clinical practice guidelines, randomized controlled trials, systematic reviews, and implementation studies addressing screening, prevention strategies, intensive lifestyle treatment, pharmacotherapy, and metabolic and bariatric surgery in children and adolescents. Results Body mass index (BMI) percentile remains the primary screening tool, with annual assessment recommended for children aged 2–18 years. Early identification should be followed by structured evaluation for comorbidities, including dyslipidemia, abnormal glucose metabolism, hypertension, and nonalcoholic fatty liver disease. Intensive health behavior and lifestyle treatment (IHBLT), defined as ≥26 hours of family-based, multicomponent counseling over 3–12 months, is the foundation of therapy and consistently produces clinically meaningful BMI reductions. For adolescents aged ≥12 years with persistent obesity, pharmacotherapy — particularly glucagon-like peptide-1 (GLP-1) receptor agonists such as semaglutide and liraglutide — has demonstrated significant additional BMI reductions. Metabolic and bariatric surgery offers the greatest and most durable weight loss for adolescents with severe obesity, with substantial remission of cardiometabolic comorbidities. Prevention efforts are most effective when multicomponent, school- and community-based, and supported by structural and policy changes. Conclusions Pediatric obesity requires early identification, active treatment, and longitudinal management within a chronic disease framework. Evidence supports a stepped, multimodal approach integrating family-centered behavioral interventions, pharmacotherapy when indicated, and surgical referral for severe disease. Addressing health inequities, improving access to evidence-based treatments, and reducing weight stigma remain essential to optimizing outcomes for diverse pediatric populations. Key Points • BMI percentile remains the standard screening tool for childhood obesity; annual assessment and structured comorbidity evaluation are recommended for all children aged 2–18 years. • Intensive health behavior and lifestyle treatment (IHBLT) providing ≥26 hours of family-based multicomponent counseling is first-line therapy; GLP-1 receptor agonists and bariatric surgery are evidence-based adjuncts for eligible adolescents. • Effective prevention and treatment require sustained, multicomponent strategies that address social determinants of health, reduce weight stigma, and expand equitable access to evidence-based interventions.

Objetivo: Evaluar los resultados funcionales después de la pieloplastia desmembrada en niños con obstrucción pieloureteral unilateral y función renal diferencial (FRD) preoperatoria ≤40%.Material y métodos: Estudio multicéntrico retrospectivo (2003–2022) que incluyó 74 niños con obstrucción pieloureteral primaria unilateral y FRD ≤40%. Se excluyeron casos bilaterales, riñón único, causas secundarias, cirugía previa o seguimiento <1 año. Grupo 1: FRD <20%; Grupo 2: 20–40%.Resultados: Mediana de edad 9 años; 50% con obstrucción derecha; 20,3% con hidronefrosis prenatal. La FRD mejoró de una mediana preoperatoria de 26% a 36,9% postoperatoria (p<0,001). La mejoría funcional >5% ocurrió en 58,1% globalmente (73,9% en G1 vs. 51,0% en G2, p=0,06). La FRD fue estable o mejoró en 93,2%. La hidronefrosis prenatal predijo deterioro postoperatorio (OR 7,12; IC95% 1,7–47,3). La duración media del seguimiento fue de 48 meses (IC 13-64).Conclusiones: La pieloplastia preserva y puede mejorar la función renal en niños con obstrucción pieloureteral y FRD preoperatoria reducida, incluso en aquellos <20%. La hidronefrosis prenatal identifica un subgrupo con mayor riesgo de deterioro postoperatorio.