Riva Kamat, MD

This baby girl was born at 37 weeks' gestation via cesarean section, with the stomach, small bowel, proximal colon, and ovary outside the body

This 14-month-old girl was brought for evaluation of marked swelling and erythema of the left eyelids (A) The mother had noticed a green discharge and mild swelling of the eye 2 nights earlier.

A 20-month-old boy brought to the emergency department with swelling on the right side of the neck and fever (temperature, 39.3°C [102.7°F]) of 1 day’s duration. The parents reported that the child had had intermittent fevers and poor weight gain for the past 3 months but no vomiting, diarrhea, rash, drooling, or difficulty in swallowing.

A 7-year-old boy was brought for evaluation of a nonpruritic, nonpainful, evolving polymorphic rash that began on the torso and spread to the extremities, face, palms, and soles over a 2-week period. He had been otherwise healthy and had no history of constitutional symptoms.

A 4-year-old boy was brought to the hospital because of fever (temperature of 39.4°C [103°F]) and a bright, salmon-pink rash on the palms and soles that was associated with peeling (A and B). His symptoms had been present for 2 days. During that time, he also had redness of the eyes, fatigue, and anorexia.

The 2-year-old boy shown here had been bitten on the left cheek by a medium-sized dog while at the home of his day-care provider. Immediately after the incident, the child was examined by his pediatrician and given a presciption for amoxicillin clavulanate. The next day, he presented to the emergency department with worsening cellulitis of the left cheek.

Most physicians in this area of New York do not do spinal taps on patients with headaches and an erythema chronicum migrans rash unless they have meningismus. Seventh cranial nerve palsy alone is not an indication for a spinal tap.

After experiencing frequent headaches, this 10-year-old girl awoke with a "funny smile" involving left-sided facial paresis. She was evaluated in an emergency department and a complete blood cell count, Lyme IgM and IgG screen, and CT scans of the head and sinuses were ordered.