Nirav Shastri, MD

A 10-year-old boy injured his left elbow during football practice. He subsequently had pain with normal range of motion of the elbow.

For the past few weeks, a 10-year-old boy had a pruritic abdominal rash that had not responded to over-the-counter topical medications. The rash had appeared around the time he started wearing a new belt (shown). The child was otherwise healthy. There was a family history of asthma.

Results of a complete blood cell count (CBC), measurements of electrolyte concentrations, and urinalysis were normal. A rapid streptococcal test result was negative. The C-reactive protein level was elevated at 3.3 mg/L (normal, less than 1 mg/L); the erythrocyte sedimentation rate was 58 mm/h (normal, 4 to 20 mm/h).

Multiple tender flaccid bullae (about 2 mm to 2 cm) were present on the perineum. There was no associated discharge. The ruptured blisters had marked erythema in the center and a scaly rim at the periphery. The Nikolsky sign could not be elicited. The infant was afebrile. The remainder of the examination findings were normal.

Three-year-old boy limping on right foot after an unwitnessed fall from trampoline the day before. Pain controlled with ibuprofen. No history of chronic diseases or routine medication use.

A 4-year-old US-born Hispanic boy presented with penile discharge and painful urination. His mother reported that he had no fever, trauma, history of masturbation, or recent travel history. She did not suspect any abuse. There had been no similar complaints in the past.

These 2 swellings on the scalp of a 13-year-old boy had appeared about 8 months earlier and had slowly enlarged. The mother had massaged the lesions when they were small in an attempt to heal them. There was no history of local trauma (eg, from hair-cutting tools) and no pain or discharge from the lesions.