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Laura Santry, MD, is a third-year PEM fellow at Nemours Children's Hospital in Delaware.

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.

Pediatric e-scooter injuries are surging as popularity rises, highlighting the need for increased awareness and safety measures to protect young riders.

The rise of electric scooter injuries: What the general pediatrician needs to know 

Aditi Rao
Final-Year Medical Student
Dr VMGMC, Solapur, India

A teenage girl with acne lesions on her forehead

. 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.

The FDA has assigned a target action date of February 28, 2026, for a potential expanded indication of pegvaliase-pqpz to include adolescents with PKU. 

FDA accepts pegvaliase-pqpz sBLA to expand treatment to patients with PKU aged 12-17 years

Horton, Jennifer, MD, University of Utah, Primary Children’s Hospital. 

Can you diagnose this 10-year-old with an oozy ear? 

Full case: Don’t turn a blind eye to an oozy ear 

Contemporary Pediatrics connects pediatricians with peer-reviewed articles, guideline updates, and practice strategies for real-world clinical application.

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Asthma is the most prevalent chronic disease in children. In the United States, asthma affects approximately 1.4 million children younger than 5 years and causes frequent activity limitations and hospitalizations.

A Guide to Monitoring and AchievingAsthma Control in ChildrenYounger Than 5 Years

**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, January 6 at 12:00 PM ET for the full case presentation, differential diagnoses, and the correct patient diagnosis. 

This case was provided by Amar Davé, MD, FAAP and Pahroul Davé, APRN

A boy aged 10 years presented to the outpatient office with a history of painful nodules on the plantar surface of his bilateral feet 8 to 10 hours after spending time in a hot tub. He was unable to bear weight or put on socks and shoes due to his pain. The photos were taken soon after the painful and red papules appeared. The lesions affected the whole plantar aspect of both feet. Over the following 4 days, the nodules became less painful and red. 

Medical advice was sought on the fifth day of symptoms, and by this time, the child was improving clinically. He was stable with subcutaneous, mildly painful, fleshy nodules mostly populating the medial arch of the foot. His remaining clinical examination results were within a normal range. Further questioning of the child’s mother revealed that other children exposed to the hot tub experienced painful feet but without lesions. 

Due to the patient’s improving symptoms and the self-limiting nature of the illness, no tests or labs were ordered as the child was not acutely ill. No peer consultations or specialists were utilized.

Click here for the full case presentation, differential diagnoses, and the correct patient diagnosis, in a separate article.

The photos in this case were taken soon after the painful and red papules appeared.

News

Case Studies

Can you diagnose this boy with painful nodules on his feet?

 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 Wednesday, October 29, 2025, at 12:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

This case was presented by Jennifer Horton, MD, and Anna Suessman, DO, MED, FAAP

A previously-healthy and fully-immunized 10-year-old male presented to an outside Emergency Department for evaluation of one week of left ear pain with itching, drainage, and associated postauricular swelling. The parent reported that the symptoms began after frequent swimming while on vacation and were not relieved by over-the-counter swimmer's ear drops. There was no history of recent trauma or insect bites. He had no prior history of recurrent ear infections, abscesses, or boils. On the day of presentation, the patient reported a mild headache and neck pain, but denied any associated fevers, upper respiratory, or gastrointestinal symptoms. The patient had no significant past medical or surgical history and had no known allergies.

Upon arrival to the Emergency Department, the patient was non-toxic appearing and in no acute distress with normal vital signs for age (HR 97, BP 108/55, T 37.7C, RR 20, and SpO2 100% on room air). Physical examination was notable for proptosis of the left ear and a considerable amount of purulent drainage obstructing visualization of the left tympanic membrane. There was also fluctuant swelling and associated tenderness of the left mastoid without overlying erythema, induration, or warmth (Figure 2).

The patient had bloodwork completed, which was significant for leukocytosis to 15.5 (ref range: 4.5–13.5 10

/μL) with a left shift and elevated CRP to 32.8 (ref range: 0.0 - 8.2 mg/L). CBC also demonstrated a normocytic anemia with Hgb 9.3 (ref range: 11.5 – 15.5 g/dL), and CMP was notable for mild hypoalbuminemia of 2.6 (ref range: 3.2 – 4.7 g/dL), but labs were otherwise unremarkable. He was started on empiric IV Ampicillin-Sulbactam (Unasyn). While awaiting transfer to a pediatric facility, the patient underwent a CT temporal bone with/without contrast, which revealed the following (Figure 3).

Below, take your best guess at diagnosing this patient

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

Want more puzzler case studies? Click here.

He had no prior history of recurrent ear infections, abscesses, or boils. Can you guess the diagnosis?

Can you diagnose this 10-year-old with an oozy ear?

New subgroup analyses from the global phase 3 zoliflodacin trial highlight the drug’s efficacy against multidrug-resistant 

, including ciprofloxacin-resistant strains, across all infection sites and patient subgroups. The data were presented at 

Zoliflodacin (ZFD) is a first-in-class spiropyrimidinetrione gyrase inhibitor with a novel mechanism of action designed to overcome growing gonococcal resistance to existing therapies. In the pivotal phase 3 randomized controlled trial (NCT03959527), a single oral dose of ZFD demonstrated noninferiority to the current dual therapy standard—ceftriaxone plus azithromycin—for uncomplicated urogenital gonorrhea. Cure rates for pharyngeal and rectal infections were also comparable between treatment arms.

According to ClinicalTrials.gov, the trial featured patients aged 12 years and older, who weighed at least 35 kg, with signs and symptoms consistent with

Urethral or cervical uncomplicated gonorrhoea as determined by either a positive culture, NAAT, Gram stain, or methylene blue test/gentian violet stain in the past 14 days prior to screening  

Unprotected sexual contact with an individual reported to be infected with NG in the past 14 days prior to screening (confirmation by a positive NAAT, Gram stain, or methylene blue test/ gentian violet stain or culture)

Zoliflodacin was granted Priority Review by the FDA on June 12, 2025, and was assigned a target action date of December 15, 2025.

Consistent results across MIC levels and resistance profiles

The new subgroup findings examined microbiological cure rates by baseline ZFD minimum inhibitory concentration (MIC) and ciprofloxacin (CIP) susceptibility. Among evaluable participants, baseline isolates had ZFD MICs ranging from ≤ 0.008 to 0.5 µg/mL. High microbiological cure rates were achieved for isolates with ZFD MICs ≤ 0.25 µg/mL—the range covering nearly all samples in the study. There were too few isolates at 0.5 µg/mL (n = 3) to draw conclusions about response at that level.

Strong outcomes across sites of infection

Microbiological cure rates at urogenital sites of infection were 96.6% among participants infected with CIP-resistant 

 and 97.4% among those with CIP-susceptible baseline 

. High rates of microbiological cure for CIP-resistant 

 were maintained for pharyngeal and rectal sites of infection, geographical location, and sex at birth.

Microbiological cure rates ≥ 91% across urogenital, rectal, and pharyngeal sites of infection for participants in the evaluable population.

Microbiological cure consistent in both ciprofloxacin-resistant and -susceptible infections

ZFD MICs ≤ 0.25 µg/mL associated with high response rates

No difference in outcomes by geography or sex assigned at birth

These results support zoliflodacin’s potential as an effective single-dose oral therapy—an important advantage for improving access, adherence, and treatment completion compared with injectable regimens. Study authors also note zoliflodacin’s stable potency across years of surveillance, further supporting its long-term potential against resistant 

Sarah McLeod, PhD, senior director of Clinical Microbiology at Innoviva Specialty Therapeutics, discussed these findings and their clinical implications in a Q&A that follows.

Q&A with Sarah McLeod, PhD, on zoliflodacin data for uncomplicated gonorrhea

The subgroup data showed high cure rates across infection sites and resistance profiles. What do these findings tell us about how zoliflodacin performs against resistant 

The rationale for evaluating zoliflodacin in this phase 3 study stems from the urgent global need for new antibiotics to treat gonorrhea, particularly in the face of rising antimicrobial resistance (AMR).

 has developed resistance to every class of antibiotics historically used to treat it, and treatment options are becoming increasingly limited. 

The phase 3 subset analysis presented at IDWeek highlighted high microbiological cure rates with zoliflodacin across urogenital, rectal, and pharyngeal sites, including against ciprofloxacin-resistant 

strains. Among participants with urogenital infections, cure rates were 96.6% for ciprofloxacin-resistant and 97.4% for ciprofloxacin-susceptible strains. 

Zoliflodacin study investigator Sarah McLeod, PhD, highlights data presented at IDWeek 2025 in this Q&A with Contemporary Pediatrics.

Michael H. Mellon, MD

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