Consultant for Pediatricians Vol 4 No 6

A 5-month-old girl was brought to the emergency department (ED) 1 day after she had fallen from a countertop swing onto a tile floor. The child had been loosely buckled in the swing when the mother stepped into the next room. The mother heard a crash and the baby crying: when she came back into the room, the baby's 5-year-old sister was trying to disentangle her from the swing. The infant did not lose consciousness, was quickly comforted, and did not vomit. However, the mother noted that the baby's right thigh seemed tender and that a "black eye" was developing on the left lid. The family lived several hours from the hospital and decided to observe the baby during the night and make the trip to the ED the following morning.

An otherwise healthy 22-month-old was referred for evaluation of a pruritic rash on her buttocks and right leg of 5 days' duration. Her mother reported that the rash had begun as red bumps and blisters on the buttocks that subsequently spread to the right leg.

As an avid reader of Consultant for Pediatricians, I would like to comment on a recently published case involving an 8-year-old boy with an erythematous left eyelid ("Photo Quiz," January 2005, page 24).

A 14-year-old African American boy presented during the winter months with a painless, nonpruritic, periumbilical rash that had been present for approximately 1 month. Initially bluish, the rash had become dark brown.

Over the past 5 years, methicillin-resistant Staphylococcus aureus (MRSA) isolates have become widespread throughout the United States as well as the world.1 In some regions, including our own Gulf Coast, MRSA accounts for the majority of S aureus isolates recovered from patients with community-acquired infections.

During a routine annual checkup, a 5-ft 8-in, 94.5-kg (210-lb) 13-year-old girl was noted to have a hyperpigmented "dirty" lesion on the back of her neck. The girl's parents were also obese. Her mother had type 2 diabetes mellitus.

With the significant decline in disease caused by Haemophilus influenzae type b and Streptococcus pneumoniae achieved through vaccination, Neisseria meningitidis has moved to the forefront. Its emergence as the most important cause of bacterial meningitis challenges the pediatrician to prevent and control this terrible disease. Meningococcal disease can be easily misdiagnosed. It may present with different clinical manifestations, and its signs and symptoms may mimic those of common viral illnesses, such as influenza. The onset and progression of meningococcal disease are rapid. Although the rate of disease is highest in infants, morbidity and mortality rates for this disease are highest in adolescents and young adults, despite the existence of effective therapies.1

This neonate was born at 34 weeks' gestational age via elective cesarean section because of breech presentation. He weighed 1950 g, and his Apgar scores were 7 and 8, at 1 minute and 5 minutes, respectively.

This 12-month-old infant comes to your office with an asymptomatic eruption of sudden onset that involves the arms and legs. The child has a mild fever.

Consultations & Comments:

Developmentally 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.