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Older Man With Weakness and TremorA 71-year-old man presents with stiffness, clumsiness, and a sense of weakness in his left arm. He is concerned that he has had a stroke. What is the most appropriate management strategy?
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Acute Lymphoblastic Leukemia Presenting as Soft Tissue MassFor 3 months, a 9-year-old boy had swelling of the left upper arm. An MRI scan obtained at another facility 1 week after onset showed extensive edema of the soft tissue at the midhumeral level. Laboratory results, including complete blood cell (CBC) count and Lyme titer, were normal.
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Tuberculosis of the Mandibular Bone and Masseter Muscle AbscessThe patient had no recent fevers, cough, or weight loss. His medical history was notable for chronic thrombocytopenia and reactive arthritis, for which he had been hospitalized. His maternal grandmother had systemic lupus erythematosus; his mother had died of congestive heart failure and emphysema.
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Red-Colored StoolThe parents of a 9-month-old boy were concerned about the bright red color of their son's feces. Over the course of an hour, the infant had 3 bowel movements that appeared to the family to be "more blood than stool." He had no fever or emesis and no history of unusual contacts or travel. There had been no change in his diet; he had not been given any dietary supplements, such as iron.
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Botulism: An Unusual Cause of Lethargy and Constipation in a 3-Month-OldA 3-month-old boy was brought to the pediatrician with a 2-day history of "moaning," lethargy, and difficulty in latching on for breast-feeding. The infant had not had a wet diaper for the past 24 hours, and his last bowel movement was more than 48 hours ago.
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ID Q & A: Answers to Infectious Disease Questions Treating Spider Bites: Is Dapsone an Option?Some studies suggest that orally administered dapsone is effective for infections caused by spider bites (eg, brown recluse spiders) in dosages of 4 mg/kg/d for 3 days. Can dapsone be used in children and, if so, at what dosage?
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White Patches on a Young Boy's TrunkA 3-year-old boy with white patches on the trunk first noticed shortly after birth.
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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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Carbon Monoxide Poisoning: Clues to Unmasking the Great MasqueraderA 14-year-old boy was brought to theemergency department (ED) by paramedicsafter he complained of dizzinessand an episode of falling down earlythat morning when he awoke to go tothe bathroom.
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Photoclinic: Asymmetric Periflexural ExanthemThis day-old, macular, blanching, nonpruritic rash had developed in the right axilla and on the right arm and right side of the trunk of a 3 1/2-year-old boy. He was otherwise asymptomatic. Other physical examination findings were unremarkable.
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Asthma Therapy Complicated by Peters Plus SyndromeThe authors describe the case of a 2-year-old girl with severe persistent asthma whose disease management was complicated by this rare clinical diagnosis.
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Eczema HerpeticumOne week earlier, a 14-month-old girl with a history of eczema was evaluated because of a diffuse rash of excoriated lesions, some of them purulent. She was afebrile. Worsening eczema with secondary infection was diagnosed. Treatment with oral clindamycin was prescribed. At follow-up, the lesions had worsened. The child had multiple excoriated papules, some of which had coalesced into plaques. She also had two 5-mm vesicles on her right shoulder. Eczema herpeticum was diagnosed clinically. Culture of the vesicles later grew herpes simplex virus (HSV).
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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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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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Polycystic Ovary Syndrome: Update on the Pros and Cons of Treatment OptionsABSTRACT: Polycystic ovary syndrome (PCOS) is the most common endocrinopathy among females of reproductive age. In adolescents, PCOS often manifests with irregular menses, hirsutism, and acne. Despite general agreement that the metabolic derangements of PCOS arise during puberty, the condition is diagnosed more often in adults than in adolescents. Treatment is focused on weight loss, menstrual cycle regulation, and amelioration of physical symptoms. Acute symptoms can be managed with combination oral contraceptives and antiandrogens and potentially with insulin-sensitizing drugs. Lifestyle modification, especially in overweight patients, can reduce symptoms and help prevent long-term health consequences.
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Hypertransaminasemia: A Diagnostic DilemmaA 4-year-old Hispanic boy was referred to our facility because of elevated levels of alanine trans- aminase (ALT) and aspartate transaminase (AST), which were detected during an evaluation of transient abdominal pain while the boy was in Puerto Rico. He was otherwise in perfect health; a review of systems was negative. His past medical history and birth history were noncontributory. Immunizations, including hepatitis B, were up-to-date. The family history was significant for tuberculosis and rheumatoid arthritis.
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Atopic Dermatitis Superinfection Caused by Staphylococcus sciuri and Enterobacter asburiaeThe rash on this 4-week-old girl had appeared 5 days earlier on her face as thickened scales on an erythematous base and subsequently spread to the scalp, shoulder, chest, abdomen, and extremities. A few bullae were noted on the neck and hands. Initial treatment with cephalexin failed to control the rash, and the infant was admitted to the hospital for further evaluation.
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Case In Point: Infantile Hypertrophic Pyloric StenosisA 7-week-old white boy presented to the emergency department (ED) with vomiting and weight loss. His parents brought him to the ED 3 weeks earlier after he had vomited for several days. Possible milk protein allergy was diagnosed at that visit, and a change from cow milk formula to an elemental formula was recommended. Vomiting subsequently increased in frequency. Nonbilious but forceful vomiting occurred with each feeding. The patient lost nearly 2 lb during the 3 weeks that followed the first ED visit.
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Posterior Urethral Valves in an InfantTen-day-old boy born vaginally at 37 weeks breech without complications. Has history of poor feeding with vomiting and has lost weight since birth. One episode of vomiting described as projectile. Ultrasonography ruled out pyloric stenosis but revealed bilateral hydronephrosis. Patient referred to the emergency department for further evaluation.
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Shoulder Dislocation in a NeonateLabor was induced at term in a 29-year-old woman who had had an uneventful pregnancy. Her baby weighed 3575 g (7 lb, 14 oz). The neonate’s left arm was internally rotated with flexion at the wrist. He had a normal grasp reflex, but Moro reflex was incomplete.
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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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Case in Point: Sandifer SyndromeA previously healthy full-term, 30-week- old infant presents to the emergency department after a 30-minute episode in which he turned blue after a feeding. His mother states that the infant was also stiff, that he "arched his back," and that his eyes "had a blank look." There was no twitching associated with this episode, and the infant had no fever, cold symptoms, or any sick contact.
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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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Cystic Hygroma in a 1-Year-Old GirlThe parents of this 1-year-old girl brought her for evaluation of a neck mass of sudden onset (A). They had first noticed the mass on the morning of presentation. The child had cold symptoms and had been snoring, but she had no history of fever, shortness of breath, wheezing, or stridor. Her activity level and appetite had not changed.
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Wilson Disease in a Teenagerhe parents of a 16-year-old girl report that during the past several months, she has exhibited behavioral changes, irritability, increased anger, depression, and anxiety. The girl had previously been healthy, and there has been no recent illness or trauma.
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Toddler With Chest Pain, Trouble Breathing, Cough After Heart SurgeryA 3-year-old boy with chest pain and trouble breathing that had developed over the past 24 hours was brought to the emergency department. The parents reported that his most prominent symptom was a cough. The chest pain appeared to worsen with coughing. He had undergone open atrial septal defect repair about 3 weeks before presentation.
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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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Secondary Syphilis Palmar LesionsThe patient denied use of new skin products, detergents, or medications. He had no pets. There was no history of recent travel, and the patient was not aware of any arthropod bites. None of his family members had a similar rash. The patient was sexually active and had had 3 partners in the past 2 years; he said he always used condoms. His history was otherwise unremarkable, as were physical findings.
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Cellulitis-Adenitis From Late-Onset Group B Streptococcus InfectionA 2-month-old infant had right submandibular swelling with inflammation and induration up to the nape of neck. Ultrasonography showed multiple enlarged lymph nodes with soft tissue swelling. Blood cultures grew Gram-positive cocci, which were identified as group B streptococci. Late-onset GBS infection is acquired from colonized household contacts.
