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Aplasia Cutis Congenita in an InfantDevelopmentally healthy 9-month-old boy brought for evaluation of congenital pale pink 2-cm plaque on left parietal scalp. Lesion relatively unchanged since birth. No history of birth trauma or scalp electrode monitoring in the intrapartum period. Mother denied varicella infection during pregnancy.
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Infant With Multiple Birthmarks and Hypertrophic Left ArmThree-month-old boy with multiple birthmarks and hypertrophic left arm. Infant was born at 38 weeks’ gestation to a 33-year-old gravida 2, para 1 after an uncomplicated pregnancy and normal spontaneous vaginal delivery. Birth weight, 3.45 kg; length, 53 cm. Both parents healthy, nonconsanguineous. No family history of growth abnormalities. Father had port-wine stains on nape and chest.
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Unexplained Bruising: Weighing the Pros and Cons of Possible CausesA 3-month-old boy was brought by his mother to his busy primary care physician’s office for follow-up of bronchiolitis when numerous bruises were noted. The mother said that the infant had a 1-week history of unexplained bruising, petechiae, and irritability. The child was referred to the local emergency department (ED) because of concern for nonaccidental trauma.
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5-Month-Old Girl With Left Facial Droop of Sudden OnsetA 5-month-old girl presented with left facial droop of sudden onset. The infant had nasal congestion for the past 2 days, but had been eating well. There was no recent history of rash, trauma, medication use, or drug allergies.
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What Is This Annular Rash?The mother of a 4-year-old boy noticed a rash on her son's left shoulder the day before. The otherwise healthy, asymptomatic boy plays outdoors daily in his hometown of West Virginia. Earlier in the week, he told his mother that he had felt a "scab" on his shoulder and had picked it off.
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Hematemesis Caused by Esophageal DuplicationA17-month-old girl was hospitalized 3 weeks earlier because of gagging and retching emesis that contained blood-streaked mucus. Her symptoms persisted and she was transferred to a tertiary care center for further workup.
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Acute Poisoning: Keys to Zeroing In on the CausePoisons have been a threat to the health and well-being of humankind for millennia. Given the ubiquitous nature of potential poisons, exposure to a toxin should be included in the differential diagnosis of patients with unexplained illnesses or unusual presentations.
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What Are Common Comorbidities in ADHD?In this expert Q&A, Julie Sherman, PhD and Jay Tarnow, MD briefly discuss the latest research findings on ADHD.
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Tularemia in a 4-Year-Old GirlDuring spring vacation, a previously healthy 4-year-old girl visited western Nebraska, where she and her family spent time along a river bank in a wooded area. After 4 days, her mother noticed 3 engorged ticks embedded in the child's scalp. The ticks were immediately removed and burned. The child also had a marble-sized swelling on the right side of her neck. Over the next few days, the child had temperatures that spiked to 39.4C (103F), with chills, generalized malaise, and weakness. There was no history of cough, myalgias, or headache.
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Adenoviral Hepatitis in an Immunocompetent ChildAdenovirus infection is usually benign in healthy children, but it can be complicated by severe or fatal pneumonia, myocarditis, and hepatitis. Consider adenovirus infection in children with fulminant hepatic failure.
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Osteogenesis Imperfecta in a 3-Year-Old BoyA 3-year-old boy who presents with blue sclerae and a history of tibial fracture following a minor trau- ma (jump from a height of less than 18 inches). Has a long-standing complaint of back pain. Mother remarks that the boy bruises easily. Medical history otherwise unremarkable.
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Adolescent Confidentiality: Where Are the Boundaries?The angry mother of a 15-year-old girl has called the office multiple times asking for the laboratoryresults from her daughter’s office visit last week and demanding to know whether the teen was “put on the pill.” Along with other lab work, tests for sexually transmitted infections (STIs) and pregnancy were performed, and the patient was given a prescription for a hormonal contraceptive.
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Pediatric Migraine: Clinical Pearls in Diagnosis and TherapySteven, a 13-year-old boy, experienced his first headache at age 7 years. The frequency, intensity, and duration of his headaches have been increasing over the past 6 months. Steven now experiences 7 to 10 headaches each month that last up to 8 hours. The headaches are associated with mild nausea, light and sound sensitivity, dizziness, fatigue, occasional abdominal discomfort, and difficulty in concentrating. Last year, he had a vomiting episode because of a headache. The pain is usually more prominent in the forehead and does not favor either side of the head. The headaches usually begin in the morning before he leaves for school. As a result, Steven has missed nearly 25% of his school days this semester; his parents are considering home tutoring for "sick children who are unable to attend school."
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Cystic Hygroma in an Infant GirlUltrasonography showed a large multiseptated cystic mass in the posterior part of the left side of the neck. No obvious vascular flow evident within the mass (Figures 3 and 4).
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Shades of GrayMedicine is at least as much art as science. Often things are not clear-cut, but rather appear in shades of gray. We offer the following list of terminology for those who don't mind thinking in terms of black or white.
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Infant With Fat-Soluble Vitamin Deficiencies Caused by Cystic FibrosisA 3-month-old African American boy was referred for evaluation of poor weight gain and vomiting. The infant had been evaluated by his primary care physician 15 times within the past 6 weeks; he had no change in symptoms despite various treatments.
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The Uncontrollable Child: Family and Educational InterventionsIt is estimated that about 20% of children and adolescents meet criteria for a mental health disorder, and a high percentage of these youths are impaired by disruptive behavior problems.
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Two Missed Cases of Abuse: Lessons LearnedA 7-month-old male infant was brought to the emergency department (ED) by his biological mother, who reported noticing dried blood on the baby's penis and in his mouth. For several hours prior, he had been in the care of her boyfriend. On physical examination, there were severe ecchymoses and petechiae on the penile glans and shaft (Figure 1), ecchymoses on the right side of the soft palate, a laceration of the lingular frenulum, and a 2-cm bruise with dried blood over the right lip.
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Hematemesis Caused by Esophageal DuplicationA17-month-old girl was hospitalized 3 weeks earlier because of gagging and retching emesis that contained blood-streaked mucus. Her symptoms persisted and she was transferred to a tertiary care center for further workup.
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Photoclinic: Hirschsprung DiseaseA 30-hour-old boy--born to a 36-year-old gravida 3, para 3, at full term via a spontaneous vaginal delivery--was noted to a have a mildly distended abdomen while in the newborn nursery. He had been breast-feeding every 2 to 3 hours and initially was spitting up about a quarter of the volume he had consumed. During the last 3 or 4 feedings, he had been spitting up most of the milk. There was no bilious emesis. He had not passed meconium.
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That’s Not My Child: A Case of Capgras SyndromeMary, aged 40 years, was referred for psychiatric evaluation out of concern that a mental health diagnosis was interfering with her ability to appropriately and safely care for her child. The patient had stated on numerous occasions that her 9-year-old daughter, had been placed in the custody of Child Protective Services and replaced by an imposter.
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Green-Colored StoolThe parents of a 7-month-old girl brought their daughter for immediate medical attention after she passed bright green-colored stool. For the past 24 hours, the child had mild fussiness and a low-grade fever (temperature, 38.1°C [100.6°F]); she also had vomiting and mild diarrhea, with yellow-colored stools. The mother was advised to begin small, frequent feedings of oral rehydration solution with gradual return to the baby's normal diet, as tolerated. Over the next 12 hours, the vomiting and fussiness decreased and the fever resolved, but the mild diarrhea persisted and stools turned bright green. The parents denied giving the child green-colored drinks or food.
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Dog Bite in a Penicillin-Allergic PatientThe patient, a 14-year-old boy, comes to see you the same day he was bitten by a dog. In the examination room, you find him seated comfortably in the chair with his right hand and arm bandaged.
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Snakebite EnvenomationWhen reaching under a shed for the frog she had been chasing, a 4-year-old girl was bitten by “something.” The parents thought the bite was from a snake because of reports of copperhead sightings in the area. The mother immediately brought the child to the emergency department (ED).
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Keratoconus With Acute HydropsThis 14-year-old boy with autism presented with sudden visual loss in the right eye. For a week, the eye had been red, irritated, and painful. Three days earlier, "a white bubble" had developed on the cornea and had begun to obscure his vision.
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ADHD Medications: A Look at Their Safety ProfileEach year in this country, physicians prescribe medications to treat ADHD in nearly 3 million children. The safety of these agents has been the subject of some debate.
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Osteomyelitis Associated With Cat-Scratch DiseaseA 3-year-old girl was hospitalized because of purulent drainage from a right middle finger wound (Figure 1) and a tender right axillary mass (Figure 2) of 2 days’ duration.
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Case in Point: Infant With an "Atypical Mole"A 6-month-old infant was brought for evaluation of an "atypical mole" on the chest that her parents and referring physician feared might be skin cancer. The parents reported that the lesion had been present since shortly after birth and had become red and inflamed after minor trauma on a few occasions and once had blistered.
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Photoclinic: Tinea CapitisThe parents of a 3-year-old girl sought evaluation of their daughter's hair loss. During the past several months, a large patch of alopecia with scaling had developed. The differential diagnosis included seborrhea, trichotillomania, and tinea capitis. Joe R. Monroe, PA-C, MPAS, of Tulsa, Okla, writes that in seborrhea, scaling typically occurs throughout the scalp without the patches of alopecia seen in this patient. Broken-off hairs--a key to trichotillomania--were absent here. A potassium hydroxide preparation of scrapings that contained hairs from the affected area were positive for the "endothrix" phenomenon--the finding of fungal elements inside the hair shaft. Palpable, tender suboccipital lymph nodes were also detected. Both of these findings are common in tinea capitis and essentially confirm the diagnosis.
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Emergent Laceration ClosureDr Crane and Mr Schoonmaker, who were at the campground, write that an inordinate amount of highway traffic resulting from a local bikers' rally prevented them from transporting the patient to a medical facility. Emergent wound closure had to be performed with available materials. After the wound was flushed, a household cyanoacrylate adhesive, Krazy Glue, was used to close the laceration. To add lateral support and to reduce the risk of wound dehiscence, Dr Crane embedded hair trimmed from the patient's scalp into a second layer of glue. To replicate wound closure tape, the hair was applied perpendicular to the laceration. Azithromycin suspension was available; 1 tsp (5 mL) was given initially followed by 2.5 mL daily for 4 days.
