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Umer Muhammad, MD, Department of Pediatrics, Charleston Area Medical Center, Charleston,West Virginia.

Articles

 and joined the MJH Life Sciences team in December 2019. She graduated from Youngstown State University in 2019 with a bachelor's degree in journalism and a minor in political science. Prior to graduating, Morgan worked as the editor-in-chief of her college newspaper. She went on to work as an assignment editor at a broadcast news station in Youngstown, Ohio before joining 

 You can reach her at mpetronelli@mjhlifesciences.com.

Can you diagnose this patient? Take our poll and find out! Then check back for the full case, differential diagnosis, and correct diagnosis.

Puzzler poll: Diagnose this 23-month-old with cough and rhinorrhea

John Browning, MD, Chief of Dermatology at Children’s Hospital of San Antonio and Organon Health Partner.

Dr. John Browning Headshot (1).jpg

. He joined the brand in March of 2023 as an editor before being promoted to senior editor in January 2024. Fitch graduated from Youngstown State University in Youngstown, Ohio in 2020 with a degree in telecommunications and journalism. He started his career as a news and sports videographer before becoming an on-air sports anchor at the NBC-affiliated news station in Youngstown. Fitch briefly worked as a national content writer for a Chicago-based national television station before joining the 

team. He can be reached at: jfitch@mjhlifesciences.com.

John Browning, MD, highlights the importance of fragrance-free, steroid-free creams in managing atopic dermatitis safely and effectively in children.

How fragrance plays a role in atopic dermatitis treatments, with John Browning, MD

A new polygenic risk score enhances obesity risk prediction from childhood to adulthood, offering new insights for early intervention and prevention strategies.

New genetic test predicts obesity risk in early childhood

Get caught up with Contemporary Pediatrics! This list helps you navigate our top stories from the week, all in one place.


Breaking down neurodiversity, nicotine ingestions increasing, and more

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A 12-year-old is brought into the office for a 10-month-old generalized itchy skin eruption.

A case of refractory atopic dermatitis

**Editor's Note** Please note that starting January 1, 2025, we will be switching to an online-exclusive publication process. This will allow us to publish case submissions quicker without having to deal with the variables that come along with print publication. All cases will still be eligible for print publication consideration, but publication in our print magazine is not guaranteed and will be up to the editor's discretion. 

Do you have a puzzling pediatric case that you’d like to share with the readers of 

We are looking for intriguing diagnoses that have stumped the experts—a diagnostic “Puzzler”—to help our physicians enhance their day-to-day practices. If you have such a story to tell, tell us.

Here’s what to do: Before you begin, we suggest that first you review the Puzzler 

https://www.contemporarypediatrics.com/case-studies

. Please note the specific style required for writing Puzzler manuscripts.

Next, prepare a draft of your case, including a summary of the presenting symptoms, a case overview, a 

table of the differential diagnosis (MANDATORY)

, and the special aspects of your case that qualify it as a Puzzler, and send it to us. Please note that the differential diagnosis table should also be discussed in the body text. We’ll review your draft and let you know what you need to add or revise before we send the manuscript to peer review for evaluation.

Puzzlers vary in length, and we suggest a minimum of 1,200 words up to a maximum of 2,000 words, but that is because of the complexity of some cases and whether some patients returned for many assessments before their diagnoses were determined. Also, some authors describe the pathophysiology of the differentials in great detail. Please also note no more than 3 authors are allowed per article.

What's most important is to show us the process that you used to analyze the case, including:

Why you decided to order certain tests and why you did not order others.

Peer consultations or why you elected to contact other specialists.

Lab values including vital signs or blood tests.

Labs and values if your patient was attended to in the emergency department or other hospital departments such as radiology or neurology.

Discussion related to the possible diagnoses.

Final diagnosis, treatment, prognosis, and follow-up.

Remember to indicate numbered citations within the body of the text and include a complete list of corresponding literature/references at the end of the manuscript. (Do not use any citation management programs or unlink them.) 

Limit references to 25. No references (unless it is a seminal study) can be older than 10 years.

We prefer primary research as references, but some cases are so obscure that authors will need to pull from a variety of sources. However, 

. Be advised that peer reviewers are adamant that the disease/disorder you describe was actually diagnosed and not determined by index of suspicion on the basis of ruling out various differentials. We use AMA11 as our publication style, which uses superscript citation numbers and a corresponding numbered reference list. Please create your citations and references in this style.  Check this recent article posted online at 

https://www.contemporarypediatrics.com/view/the-rx-of-adhd

 for examples of reference style. IMPORTANT NOTE WITH AMA 11TH EDITION: PLEASE PUT DOI OR WEBSITES/URLS AT THE END OF THE REFERENCE LINE.

When you send your draft manuscript, also 

. These image files must be high-resolution jpg or tiff files (minimum of 300 dpi) and as large in size as possible. We suggest a minimum of 7 horizontal inches. The images must be original photos with clear permissions to use, not images from copyrighted sources. Send as separate attachments with your e-mail submission; do not embed images into your manuscript document.

After we receive your manuscript, our editors and peer reviewers will review your draft and let you know if we accept your submission for publication. 

Puzzler is one of the departments for which we receive the most submissions, so it may be several months after submission before you receive feedback from us.

If we do accept your submission for publication, we will contact you with further instructions.

Send your submissions in Microsoft Word format to 

, via e-mail to mpetronelli@mjhlifesciences.com

Guidelines for PUZZLER, Contemporary Pediatrics

 poll. Take a look at the following case below. After reading through the description, choose a multiple choice answer and try to guess the correct patient diagnosis. 

 on Monday, March 24, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Muhammad Aamir Anees and Bernard A. Cohen, MD

Want more puzzler and dermatology cases? 

A healthy 9-year-old girl developed an asymptomatic eruption of discrete and confluent, 2 to 3 mm, hypopigmented papules in a linear pattern along the lines of Blaschko on the back of her left thigh and leg over the past 3 weeks. The lesions cleared without treatment 4 to 5 months later. 

Inflammatory linear verrucous epidermal nevus

on Monday, March 24, 2025 at 12:00 PM ET or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

Take your best guess and try to diagnose this 9-year-old girl's linear eruption on the back of her left thigh and leg. Stay tuned for the full case presentation and correct diagnosis! 

News

Case Studies

Poll: What's the diagnosis of this linear eruption on the leg of a 9-year-old girl?

Discover the latest in pediatric infectious diseases with Infectious Insights, a new podcast series hosted by expert Tina Tan, MD, FIDSA, FPIDS, FAAP.

Introducing Infectious Insights, a new pediatric infectious disease podcast

 are proud to announce the launch of a new video podcast series, Infectious Insights, a trusted source for the latest updates in pediatric infectious diseases—designed specifically for pediatricians, by pediatricians. 

The podcast aims to provide a space to break down the latest developments, clinical guidance, and emerging data in infectious diseases, so you can stay informed and ready to deliver the best care to your patients.

 Editor-in-Chief Tina Tan, MD, FIDSA, FPIDS, FAAP. 

Tan is a professor of pediatrics at the Feinberg School of Medicine at Northwestern University and a pediatric infectious diseases attending at Ann & Robert H. Lurie Children’s Hospital of Chicago. She also directs the International Adoptee Clinic and co-directs the Pediatric Travel Medicine Clinic. Her work has focused on pneumococcal infections, pertussis prevention, antibiotic resistance, and vaccine education—areas she continues to study through clinical care and research.

In addition to her clinical and academic roles, she serves as the current president of the Infectious Diseases Society of America. She is also chair of the American Academy of Pediatrics Section on Infectious Diseases and serves on the Red Book Committee, while contributing to immunization and antimicrobial stewardship efforts nationally and globally.

Our hope is that our audience walks away from this podcast with a better understanding of the current state of infectious disease and the tools to strengthen their practice to make sure their patients are happy and healthy.

We look forward to the productive conversations that will take place in this podcast, if you have any infectious disease questions you want answered, please send an email to mebert@mjhlifesciences.com 

Please click here to view our first episode of 

with our first guest, Candice Jones, MD, a board-certified pediatrician based in Orlando, Florida.

The first episode highlights what clinicians need to know this vaccine season amid uncertainty, vaccine hesitancy and new vaccine frameworks. 

clinician poll. This poll goes hand-in-hand with our 

, that has been published in the dermatology section of our January/February issue of 

Take a look at the case synopsis and try to make the correct diagnosis with the poll below. After, click the link that appears for the full case study with differential diagnosis and patient management.

A 4-year-old boy developed edematous, itchy, painful hands and fingers with erythema while playing out in the snow. The most severe involvement was localized to his upper extremities, specifically in his right index and pinky finger and left pinky finger. The child was otherwise healthy with no prior severe medical issues, and he did not present with COVID-19 symptoms.

Read the case and take your best guess at diagnosing this 4-year-old patient.

Clinician poll: Can you diagnose this child with itchy, red, and painful hands?

 poll. Take a look at the following case below. After reading through the description, choose a multiple-choice answer and try to guess the correct patient diagnosis.

Then, visit our website on July 9, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

This case was provided by Drashti Patel, BS, BA, and Jyoti Budania, MD.

In November 2023, an otherwise healthy 11-year-old boy presented to the clinic with the chief complaint of testicular discomfort. He reported mild testicular pain that worsened with physical activity, and he denied the presence of dysuria, urinary urgency, or frequency. He was recently evaluated by ENT for an episode of epistaxis, which was benign and resolved without requiring cauterization. His medical history was otherwise unremarkable, notable only for molluscum contagiosum at5 years of age and a few episodes of streptococcal pharyngitis and otitis media.

His vital signs in clinic were within normal limits, and the only additional finding at this time was a nontender, nonpruritic, and nonpalpable petechial rash on the bilateral lower extremities. His mother observed that the rash appeared to fluctuate with his activity level, worsening during periods of increased stress or activity.

Given the presence of petechiae, an initial workup was initiated, including a complete blood count (CBC), comprehensive metabolic panel (CMP), prothrombin time (PT), and partial thromboplastin time (PTT). A point-of-care urinalysis performed in the clinic revealed traces of blood in the urine. The patient appeared well and did not show any other signs of illness. He was diagnosed with viral epididymitis while pending laboratory results. He was advised to remain hydrated and to return for follow-up if his symptoms persisted or worsened. His mother agreed with this plan and committed to closely monitoring his rash.

Over the following week, he returned to our clinic. His rash had progressed, spreading to his thighs, buttocks, and the distal shaft of his penis. All of his previous labs were within normal limits, and additional workup was initiated, including a platelet function assay and measurements of serum IgA, C3, and C4 levels, along with a repeat urinalysis.

Below, take your best guess at diagnosing this patient

Idiopathic thrombocytopenic purpura (ITP)

Now, click here for the full case presentation, differential diagnosis, and correct patient diagnosis. 

Thank you for taking this Contemporary Pediatrics poll! Want more puzzler case studies?

Can you diagnose this 11-year-old with a petechial rash?

This case was presented by Rutva Vora, BS; and Monica Guirguis, DO.

A 2-month-old female was born after an uneventful pregnancy at 40 weeks’ gestation via vacuum-assisted vaginal delivery to a G2P1011 female. The patient’s APGAR scores were 7 and 9 at 1 and 5 minutes, respectively, at birth. No bleeding or other complications were reported during delivery. The newborn and mother were discharged two days after delivery without requiring NICU stay or interventions. The infant briefly developed a small soft palpable scalp swelling that resolved within days after delivery. The patient followed an otherwise uncomplicated growth progression since birth. She did exhibit mild reflux symptoms, which were managed with supportive care measures. Physical examination after delivery and subsequent exams revealed no abnormalities, including no signs of scalp swelling or injury.

At 8 weeks of age, the patient presented to the Emergency Department with a 3-day history of new-onset scalp swelling. The parents decided to seek medical attention after the swelling became noticeably enlarged. Parents denied any changes in her mental status, vomiting, fevers, lethargy, irritability, or any other new concerns. She did have symptoms of gassiness and fussiness that were unchanged from baseline. No history of trauma was reported, and there were no concerning signs suggestive of nonaccidental trauma. The patient appeared well, with a soft, fluctuant palpable subcutaneous fluid collection overlying the parieto-occipital scalp, without crossing suture lines. The anterior fontanelle was soft and non-bulging, and there was no hemotympanum.

Bleeding disorder (e.g. Von Willebrand Disease)

Isabelle Auger, MD

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