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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.
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Photoclinic: Swallowed BeadsThe patient is an 8-year-old girl with a history of asthma and developmental delay. She complained of hip pain, and her pediatrician referred her to a pediatric orthopedist for consultation. Hip x-ray films were ordered; they revealed 3 round beads in the child's appendix.
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Rashes and Fever in Children:ABSTRACT: Children who present with rash and fever can be divided into 3 groups: the first group includes those with features of serious illness who require immediate intervention. The second and third groups include those with clearly recognizable viral syndromes and those with early or undifferentiated rash. The morphology of lesions among children with symptoms of serious illness offers clues to the underlying cause. Purpura or ecchymoses in a well-appearing child may not be associated with serious illness; a large percentage of children who present with fever and purpura have Henoch-Schönlein purpura. Kawasaki disease typically manifests with blanching rash and fever. Vesicular or bullous lesions and fever are the hallmark of erythema multiforme, toxic epidermal necrolysis, and staphylococcal scalded skin syndrome. Umbilicated papules and pustules are the sine qua non of molluscum contagiosum and varicella.
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Blaschko Lines:Following "Lines of Evidence" to a Rash DiagnosisMany factors can be considered in attempting to establish the cause of a skin disorder. These include the color, morphology, and location of the lesions; associated symptoms, such as itching and fever; and exposure to drugs or to other children who have a rash. Linearity of the lesions may also suggest the diagnosis.
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Case In Point: Aberrant Left Coronary ArteryA 2-year-old girl was seen by her pediatrician because of a 3-day history of runny nose, cough, congestion, and low-grade fevers. A viral upper respiratory tract infection was diagnosed and supportive care was recommended. The child returned 2 days later with persistent cough, mild tachypnea, and an episode of vomiting. The cough and tachypnea prompted the pediatrician to order a chest film, which revealed an enlarged cardiac silhouette.
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Teen With Swollen Eyelid and Ocular DischargeA 13-year-old boy presented with marked periorbital swelling of the left eyelid that started 12 hours earlier. His eyelashes and lid were matted with yellow discharge. He did not wear contact lenses or eyeglasses and denied ocular trauma or foreign bodies. He had been nauseated and vomited once; his mother attributed these symptoms to an antibiotic he had been taking for 5 days for a sinus infection. The medical history was noncontributory; there was no family history of ocular problems.
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Musculoskeletal Clinics: 16-Year-Old Camper With Tibial PainA 16-year-old boy complains of right lower leg pain that began 2 weeks earlier, after his first week at a summer basketball conditioning camp. Before he left for the camp, he was jogging off and on, averaging a few miles a week. At camp he began running 7 miles a day and doing sprints 3 times a week.
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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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Pediatric Urology Clinics: Reddish Urine Stain in the Diaper of a 3-Week-Old BoyA mother brought in her 3-week-old son on the day she discovered a reddish urine stain in the baby's diaper. There was no stool in the diaper. The boy had been circumcised on the second day of life, and the mother was concerned that her son might have experienced a complication of the procedure.
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Photo Essay: Images of TuberculosisTuberculosis (TB) remains one the most important infectious diseases in the world. More than 8 million people are infected every year. The vast majority of infections--95%--occur in developing countries, where the disease accounts for 25% of avoidable adult deaths.
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Atypical Kawasaki Disease and HepatosplenomegalyA 4-month-old boy was transferred to our center from a community care hospital because of persistent fever (temperature up to 39.4°C [103°F]) of 5 days’ duration. He also had decreased activity, increased irritability, occasional vomiting after feedings, and a few episodes of loose stool.
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Photoclinic: Vaccine-Induced Herpes ZosterIn the Photoclinic item titled "Vaccine-Induced Herpes Zoster," by Julie L. Cantatore-Francis, MD, and Yelva Lynfield, MD (Consultant For Pediatricians, June 2005, pages 290 and 291), the dosage of acyclovir was incorrectly printed as 80 mg/d divided into 4 doses. The correct dosage is 80 mg/kg/d divided into 4 doses. We apologize for the error.
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A Toddler Intolerant of Tube FeedingA 22-month-old boy with failure to thrive presented with a 3-day history of rhinorrhea, fever, and abdominal pain associated with tube feeding. A PEG tube had been placed 2 months before this visit.
