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Complicated Cutaneous AnthraxA 12-year-old girl presented to the emergency department with progressing generalized inflammatory symptoms (fever and malaise), visual difficulty, severe inspiratory dyspnea, and 2 painless lesions on the right upper lip that had persisted for a few days. She had been well until 2 days before presentation, when she noticed a small pimple-like lesion above the right upper lip that was followed rapidly by facial edema, erythema, and constitutional symptoms.
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Photoclinic: Immediate Pressure UrticariaAn otherwise healthy 10-month-old boy was brought to an allergy clinic for evaluation of atopic dermatitis and chronic rhinitis. On arrival at the clinic for aeroallergen and milk prick skin testing, a rash was noted that was different from his usual atopic dermatitis. The rash had not been present 2 hours earlier when the mother dressed the child and placed him in his car seat during the ride to the clinic.
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Henoch-Schönlein Purpura in a 14-Year-Old BoyAntibiotic side effect? Diffuse abdominal pain, vomiting, and anorexia led to this initial misdiagnosis in an adolescent male. The full story, here.
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Adolescent With Syncope-Or Something Else?A 16-year-old boy presented for evaluation of asthma and exercise-induced bronchospasm. His parents recalled an episode 2 months earlier in which the patient, while jumping on a trampoline and wrestling with his brother, felt like he could not catch his breath. He took a puff of his rescue inhaler, and soon after, passed out. He remained unresponsive for 2 hours.
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Case In Point: Toxic Shock SyndromeA 12-year-old boy was brought by ambulance to the emergency department (ED) with fever and shaking of 3 days' duration. He was accompanied by his mother. The boy had spent the weekend at his father's home when he began to feel sick. Since returning to his mother's house, he has been lethargic and has had one episode of vomiting.
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Case in Point: Hypophosphatemic RicketsA 6-month-old white girl presented with a 2-day history of fever and respiratory symptoms. Initially, she was admitted with a diagnosis of respiratory syncytial virus bronchiolitis. In addition to her respiratory findings, widespread signs of rickets were found--ie, frontal bossing, rachitic rosary, widening of the wrists, and double maleoli.
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Child With "Burns" on the TongueA healthy 4-year-old girl presented to the emergency department (ED) with suspected inflicted burns on the tongue. Initially, the patient had complained of a burning mouth to school staff. On direct questioning by the principal, the child said her mother had burned her tongue with a cigarette. School staff noted the lesions.
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Streptococcus IntertrigoA 3-week-old boy was referred for evaluation of suspected herpes simplex virus (HSV) infection in the inguinal and pelvic regions. The rash had reportedly worsened since its appearance 2 days earlier and was associated with a foul smell.
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Galactorrhea of the Newborn (Witch’s Milk)The mother of a 5-week-old boy was concerned about a swelling under her infant’s right nipple. A 2-cm, movable subareolar mass was palpated on examination.
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An Active 15-Year-Old Girl With a Rash on Both FeetA15-year old girl presented with a rash on both feet that had appeared a month earlier. Initially the rash looked like bruising at the base of both large toenails.
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Young Girl With “Bumpy” Red EyeFive-year-old girl with redness and light sensitivity of the right eye of 2 days' duration. She denied any significant pain or decreased vision. She initially presented to an urgent care clinic, where application of polymyxin B/trimethoprim eye drops 4 times a day was prescribed.
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Hydrocephalus Secondary to GBS MeningitisA female infant born at 29 weeks' gestation after premature membrane rupture was admitted to the neonatal ICU in respiratory distress.
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Congenital Complete Inguinal-Scrotal HerniaThis baby was born at term via spontaneous vaginal delivery. A large left-sided inguinal hernia that completely filled the scrotum was obvious at birth (A). An ultrasonogram confirmed a complete bowel-containing inguinal-scrotal hernia. No hernia was present on the right side. Both testes were descended. The scrotum is shown after the hernia was reduced by manipulation (B).
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GastroschisisThis baby girl was born at 37 weeks' gestation via cesarean section, with the stomach, small bowel, proximal colon, and ovary outside the body
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Henoch-Schönlein purpura with gastric wall thickeningFor 3 days, a 7-year-old girl had severe, generalized abdominal pain. The patient described the pain as sharp and achy without radiation; she denied any relieving or aggravating factors. She also reported decreased appetite and energy for the past week.
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ScrofulaA 16-year-old Asian American girl presented for evaluation of a cyst on the anterior neck that had become enlarged and inflamed over the past 9 months. She also had a productive cough for 1 month. There was no history of night sweats, weight loss, or fever.
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Photoclinic: RingwormA 5-year-old boy, who lives on a farm and routinely plays with his pet dogs, presented with these scaly, inflamed macules with a central clearingon the abdomen (A) and forehead.
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ADHD: Answers to Questions Physicians Often AskThere are many exciting new studies of the biologic basis of ADHD that use neuroimaging and genetic testing. However, none of these methods can reliably diagnose this complex disorder. Someday, these technologies will be used to help subtype ADHD and improve treatment matching.
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Perianal Pinworms (Enterobiasis)The mother of a 4-year old girl complained that the child had been "pulling at her bottom" for several weeks, presumably imitating her younger brother. Visual inspection of the area revealed the real problem.
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Chronic Bullous Disease of ChildhoodA 4-year-old, previously healthy girl presented to a tertiary care children’s hospital emergency department (ED) with large, tense bullae involving up to 40% of her body surface area. The patient’s parents described a 12-day history of itchy, papulovesicular lesions that had progressed into large blisters.
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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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Drug Eruptions: The Benign-and the Life-Threatening“Drug rash” is a common pediatric complaint in both inpatient and outpatient settings. This term, however, denotes a clinical category and is not a precise diagnosis. Proper identification and classification of drug eruptions in children are important for determining the possibility of-and preventing progression to-internal involvement. Accurate identification is also important so that patients and their parents can be counseled to avoid future problematic drug exposures.
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ADHD and the Adolescent Driver:ABSTRACT: Adolescent drivers with attention deficit hyperactivity disorder (ADHD) are more likely to be involved in--and to die of--a driving accident than any other cause. The higher occurrence of driving mishaps is not surprising given that the core symptoms of ADHD are inattention, impulsivity, and hyperactivity. Safe driving habits can diminish the risk, however. The first step is to inform patients of the dangers of driving; the significance of adolescence, ADHD, and medication can be underscored in a written "agreement." Strategies to promote safer driving--especially optimally dosed long-acting stimulant medication taken 7 days a week--may be critical. A number of measures lead to safer driving by reducing potential distractions during driving (eg, setting the car radio before driving, no drinking or eating or cell phone use while driving, no teenage passengers in the car for the first 6 months of driving, and restricted night driving).
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Intussusception With a Pathological Lead PointA 4-month-old girl was admitted to a rural hospital with nonbilious vomiting and bloody stools that began the prior evening. The parents reported that the infant had periods of excessive irritability mixed with periods of calm. She had no fever, exposure to illness, or surgical history.
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What Rx Findings Reveal About Teenage Boy’s Elbow PainA 15-year-old boy presents with pain in the medial aspect of his right elbow that began 4 to 6 weeks earlier and progressively worsened.
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Reversibility of TPN-Induced CholestasisA 6-month-old boy was hospitalized because of fever and suspected central line sepsis. He had been receiving total parenteral nutrition (TPN) since shortly after birth following a small-bowel resection, which was performed to repair a midgut volvulus. Abdominal ultrasonographic findings after the procedure were normal. The infant was born at term after an uneventful pregnancy and delivery. Alkaline phosphatase and γ-glutamyl transpeptidase levels were elevated, without hyperbilirubinemia. An ultrasonogram showed hyperhomogeneous and nonhomogeneous echogenicities of the liver, consistent with fatty changes and fibrosis.
