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Case in Point: An Unusual Injury to the MouthA 2-year-old boy was brought to the emergency department by his mother after he slipped and fell in the bathtub. The boy's father, who had been bathing the child when the injury occurred, reported that he had briefly turned his back while the child was attempting to drink from the hook-shaped faucet. The child had jerked his head upward when he fell, thus causing the sharp edge of the faucet tip to lodge in the soft floor of the mouth beneath the tongue. The father, in desperation, wrenched the faucet from its base and then was able to remove the tip from the child's mouth. During the removal process, the child reached up and also cut his finger on the sharp edge of the faucet.
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Did a Vaccine Cause this Disease?Active, healthy 11-y/o boy develops degenerative neurologic symptoms. PMH relevant for measles at age 1 year, MMR vaccine at 8 months. Is there a connection?
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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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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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A Young Girl With Unexplained Cervical Lymphadenopathy: Infection? Lymphoma--or Something Else?An 11-year-old African American girl was hospitalized with new fever in the context of unexplained cervical chain lymphadenopathy. WBC and ANC were low, ESR and LDH levels were elevated. Does the image here offer a clue to the ultimate diagnosis?
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Pediatric Vasculitic Syndromes:A 7-year-old boy presented to his primary care pediatrician with a 24-hour history of vomiting, abdominal pain, and low-grade fever. The child appeared stable. A viral illness was diagnosed. The child was sent home, and his parents were advised to give him adequate fluids as well as acetaminophen as needed for fever.
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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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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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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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Photoclinic: Arachnoid CystThe parents of a 7-year-old girl, who had fallen off her bicycle and hit her left forehead 2 weeks earlier, brought their daughter to the emergency department after she began having increasingly severe headaches. She had been healthy before her fall and had no history of other trauma or meningitis. She had no neurologic deficits on presentation. Examination of the fundus revealed no papilledema.
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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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Omental Cyst Presenting as Acute AbdomenA 2-year-old girl was transferred to the pediatric ICU from a nearby community hospital because of nonremitting, generalized abdominal pain associated with fever and vomiting. Her symptoms had begun 3 days earlier and had progressively worsened despite treatment with antibiotics, pain medication, and fluids.
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Photoclinic: Varicella-Zoster InfectionA 9-year-old girl was hospitalized because of a painful, vesicular rash on her genitals, groin, and buttocks. There was also concern about possible genital herpes infection in a minor.
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Polycystic Ovary SyndromeA 13-year-old girl presented to her primary care pediatrician for continuing evaluation of intermittent right lower quadrant and right hip pain of 7 months' duration. As part of the workup, a pediatric orthopedist had ordered an MRI scan of her pelvis. The findings were normal except for the presence of multiple ovarian follicles bilaterally (Figures 1 and 2).
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Photoclinic: Winged ScapulaA 14-year-old girl presented with concerns about a "deformed" right shoulder. Despite the fact that there was no associated weakness, the defect made her self-conscious. She denied recent trauma to the site and severe physical exertion.
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Young Boy With Different Colored EyesA 6-month-old boy with different colored eyes since birth. The parents are concerned that the eye anomaly may be associated with an underlying condition after reading about eye disorders online.
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Solitary Nodule With a Positive Darier SignSeventeen-month-old Hispanic boy with 7-month history of a swelling on his back. Lesion first looked like a small "scar," then gradually grew over next few months. Lesion appeared to blister, with subsequent discharge of clear fluid. No symptoms other than intermittent pruritus at lesion site. Patient not taking any medications.
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Allergic Reaction to Nickel in Swallowed CoinsAn 8-year-old boy seen at a gastroenterology clinic after "accidentally" swallowing 2 coins 4 days earlier. Had difficulty in breathing shortly after swallowing the coins and was taken to emergency department. X-ray films at that time demonstrated coins in his esophagus. Patient was immediately transferred to a tertiary care facility. Repeated x-rays showed the coins in his stomach. Patient was sent home with instructions to follow up with his pediatrician in 1 to 2 days.
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Adolescent Scoliosis: REFERENCES:ABSTRACT: Patient compliance is a significant problem in exercise therapy and bracing for adolescent scoliosis, and exercise has been considered to have no therapeutic benefit. According to recent studies, however, muscle function asymmetry is a consistent finding in patients with this condition and is correctable with progressive resistance exercises. Patients' baseline and progress can be quantified accurately with exercise by performing precise measurements of torso rotation and lumbar strengthening. Strengthening is associated with control of scoliotic curves, if they are below the operative level. Because even some decrease in the amount of curve may be expected, this form of therapy may be as beneficial as bracing. The treatment also may be used for controlling pain in older patients with scoliosis.
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A 3-Year Old Girl with a Rash on Left Arm, Flank, and ThighA 3-year old girl presents with a 4-week history of rash on her left arm, flank, and thigh. The rash is non-pruritic and non-painful. The patient is taking no medications and is up-to-date on all immunizations.
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Bone Pain, Bruising, and Epistaxisin a Young BoyA 5-year-old boy was brought for evaluation of ongoing thrombocytopenia before undergoing adenotonsillectomy for obstructive sleep apnea. The child had been given a diagnosis of "growing pains" after frequent evaluation for leg pain over the past 2 years.
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Child With Bullous Lesion on Left Side of GroinA 16-month-old Hispanic girl presented with a 2-day history of pain, redness, and swelling of the left side of her groin. Her mother first noticed the lesion after the child was seen limping and scratching the area. The mother thought her child had been bitten by an insect but did not witness any bite.
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Case in Point: Acute Osteomyelitis: Radiographs Versus MRIA 10-year-old boy with no medical history was brought to his pediatrician's office with a 2-day history of intermittent fever (temperature of 38.8°C to 39.4°C [102°F to 103°F]). Physical examination results were unremarkable. There was no history of recent trauma. The child was sent home with analgesic therapy.
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Dyskeratosis Congenita: An Inherited Bone Marrow Failure SyndromeAbnormal pigmentation, nail dystrophy, and leukoplakia may signal dyskeratosis congenita.
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Pruritus in Children:In children, most causes ofitching are the result of skin disease,not underlying systemic illness. The mostcommon dermatological causes of pruritusare atopic and contact dermatitis,urticaria, miliaria rubra, infections, insectbites or infestations, xerosis, and aquagenicpruritus. A careful history andphysical examination usually reveal thediagnosis. The location, chronicity, timeof occurrence, and nature of the itchingoffer important diagnostic clues, as doprecipitating factors, associated symptoms,drug use, exposure to infectious diseasesor pets, psychosocial history, past health,and family history. Treatment of the underlyingcause of itching should beaddressed whenever possible. Symptomatictreatment is essential to breakthe itch-scratch cycle.
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Two Teens With Retrosternal Chest Pain and OdynophagiaA previously healthy 14-year-old girl presented with retrosternal chest pain, odynophagia, and dysphagia of 10 days' duration. Her medical history was unremarkable. Results of an ECG and a chest radiograph were normal. An upper GI series revealed an abnormality at the level of the mid esophagus. She was treated with lansoprazole and sucralfate for a week; however, her symptoms persisted and perhaps worsened slightly. She lost 2.3 kg (5 lb) during her illness and was referred to a pediatric gastroenterologist.
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Toxic Epidermal Necrolysis Secondary to Anticonvulsant MedicationA 15-year-old girl was brought to the emergency department because of bilateral shoulder and hip pain associated with myalgia and fatigue. The symptoms had been present for 2 months and had increased in intensity over the past few days. The patient had systemic lupus erythematosus, asthma, and seizure disorder.
