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. 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.

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.

Pegcetacoplan (Empaveli: Apellis PHarmaceuticals) is indicated for patients aged 12 years and older to reduce proteinuria.

FDA approves pegcetacoplan as first treatment for C3 glomerulopathy or IC-MPGN

Suzanne Hollander, MS, RD, LDN, Senior Clinical Nutrition Specialist, Boston Children's Hospital. 

Suzanne Hollander, MS, RD, LDN and Timothy Tramontana, MD offer thoughts on the newly FDA-approved sepiapterin for PKU. 

WATCH: Experts react to the FDA approval of sepiapterin to treat PKU

“Without treatment, individuals with PKU would have very high blood Phe levels... so that results in neurocognitive deficits and mood disorders," Suzanne Hollander, MS, RD, LDN.

FDA approves sepiapterin to treat phenylketonuria in adult, pediatric patients

The FDA has approved avatrombopag and new sprinkle formulation for children ≥1 year with chronic ITP, offering an oral, food-flexible treatment option.

FDA approves avatrombopag for pediatric immune thrombocytopenia, including new sprinkle formulation

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

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Authors

Timothy Tramontana, MD, medical and biochemical geneticist, Cleveland Clinic Foundation.

**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.

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

News

Case Studies

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

Then visit our website on July 23 at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis. 

This case was presented by Umer Muhammad, MD; Neil Copeland, MD; and John Bishara, DO

A 23-month-old girl presented with a 3-day history of cough, rhinorrhea, and increased work of breathing. Initially, she was treated for bronchiolitis at an urgent care center, where a nasopharyngeal swab identified adenovirus. Despite initial treatment, the patient's condition worsened, and she required oxygen supplementation via nasal cannula for oxyhemoglobin desaturation. Her hypoxemia further deteriorated, necessitating an increase in oxygen supplementation (

On physical examination, the patient showed signs of respiratory distress. A chest x-ray (CXR) revealed opacities in the right middle and lower lobes. The patient's condition improved with supportive care, and she was discharged after several days in the hospital. 

However, 9 months later, due to recurrent wheezing, she was referred to the pulmonary service for further evaluation. A follow-up CXR, taken 3 months after the initial infection, demonstrated complete opacification of the right hemithorax, with a mediastinal shift to the right, as well as collapse of the right upper and middle lobes. 

Congenital pulmonary adenomatoid malformation (CPAM) 

website on Wednesday, July 23, at 3:00 PM EST or later for the full case presentation, differential diagnosis, and correct patient diagnosis.

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

 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! 

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

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

For pediatricians treating children with atopic dermatitis, safe and effective topical options are now more accessible and increasingly important to understand, says John Browning, MD, chief of dermatology at Children’s Hospital of San Antonio.

“Pediatricians should be very confident to prescribe steroid-free creams,” Browning said. “They can and should do that when they see a patient.” In many cases, children first present with symptoms of eczema during routine visits or sports physicals, he noted, making the pediatrician the first opportunity for timely intervention.

Having a nonsteroidal, fragrance-free treatment readily available “is great,” Browning said, particularly given the limited number of pediatric dermatologists. 

“Otherwise, those patients are going to suffer before they’re finally going to be seen by a pediatric dermatologist. Fragrance is a major player in both irritating atopic dermatitis but also in causing allergic contact dermatitis,” he explained, noting that in children with eczema, even common daily products such as cleansers, shampoos, or moisturizers can be problematic.

“People with atopic dermatitis have a lower threshold for irritation from fragrance. If you look at the top 10 list for cutaneous allergies in children, fragrance is going to make that list every single time,” Browning said. 

He urged pediatricians and caregivers to look for products labeled “fragrance free” rather than simply “unscented” products, which may still contain masking fragrances. “Oftentimes, it doesn’t even list 'fragrance.' It may use a funny word like ‘parfum,’” he said. “Even things like essential oils should really be avoided if you’ve got a child with sensitive skin and eczema.”

Browning highlighted the December 16, 2024, 

FDA approval of tapinarof cream 1% (Vtama)

, which is indicated to treat atopic dermatitis in patients 2 years or older.

“This product is fragrance free. It’s not irritating to the skin. It doesn’t have harmful preservatives or things like petroleum jelly,” he said. “Thankfully, now we’ve got newer products that don’t have some of the harmful ingredients.” 

Tapinarof cream 1% demonstrates positive long-term results for atopic dermatitis in patients 2 years and up

Editor's note: A relevant disclosure for Browning is Organon

1. Fitch J. FDA approves tapinarof cream, 1% for atopic dermatitis patients 2 years and up. 

. December 16, 2024. Accessed June 11, 2025. https://www.contemporarypediatrics.com/view/fda-approves-tapinarof-cream-1-for-atopic-dermatitis-patients-2-years-and-up

2. Ebert M. Tapinarof cream 1% demonstrates positive long-term results for atopic dermatitis in patients 2 years and up. 

. March 10, 2025. Accessed June 11, 2025.  https://www.contemporarypediatrics.com/view/tapinarof-cream-1-demonstrates-positive-long-term-results-for-atopic-dermatitis-in-patients-2-years-and-up

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

Pediatric pulmonologist Richard Wong, DO, outlines how school environments can complicate asthma management for children across all age groups.

Richard Wong, DO, explains challenges children with asthma face in school

Pediatric pulmonologist Richard Wong, DO, outlines how school environments can complicate asthma management for children across all age groups. 

Timothy Tramontana, MD

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