Pediatric Puzzler

image of 8-year-old girl with swelling on right side of neck

8-year-old girl with pain in her neck

October 17, 2019

A mildly overweight 8-year-old Hispanic female in rural Colorado is brought to her primary care provider’s office with right neck pain and right-sided neck swelling of a day’s duration. The patient’s mother also stated that her daughter had a maximum temperature (T-max) of 102°F that started that morning. The patient denied any sore throat, rash, headache, rhinorrhea, cough, nasal congestion, abdominal pain, vomiting, or diarrhea. What's the diagnosis?

image of infant with IUGR and emesis

Sudden neutropenia and emesis in an SGA infant

August 21, 2019

A 24-year-old G2P1001 African American female at 38.2 weeks of gestation was induced for labor for a fetus with prenatally diagnosed intrauterine growth restriction (IUGR). She subsequently delivered via normal spontaneous delivery. The infant initially latched well at the breast, was normoglycemic and normothermic, but shortly after birth had had a significant episode of blood-tinged emesis (not deemed to be swallowed maternal blood) and was transferred to the transitional nursery for further evaluation.

image of CT scan

Massive splenomegaly in a 6-year-old girl

July 16, 2019

A 6-year-old female with history of previously resolved iron-deficiency anemia presents to the emergency department (ED) for numerous episodes of nonbloody, nonbilious vomiting and diffuse abdominal pain that began on the day of presentation. She had initially presented to her pediatrician who felt a large left-upper-quadrant abdominal mass and referred her to the ED for further evaluation. She has no associated diarrhea or urinary symptoms. What's the diagnosis?

Fever and neck swelling in a teenaged girl

June 6, 2019

A previously healthy 15-year-old female presents to the emergency department (ED) with complaints of right-sided neck swelling, pain, decreased range of motion, and fever for 3 days. She also reports a sore throat and mouth pain with decreased oral intake. She denies any rhinorrhea, shortness of breath, difficulty swallowing, vomiting, or dental pain. What's the diagnosis?

Fever, conjunctivitis, rash, and belly pain

May 1, 2019

A 3-year old male presents with 3 days of fever (maximal temperature, 105°F), diffuse abdominal pain, and several episodes of nonbilious, nonbloody emesis and loose nonbilious, nonmucousy stools. On day 3 of illness, he was seen at an urgent care clinic where he was diagnosed with acute otitis media and prescribed amoxicillin and ondansetron. He could not tolerate any oral intake and developed red eyes, abdominal pain, and redness of his hands and feet. Later that same night, he presented to the pediatric emergency department and was admitted to the pediatric ward for management of his fever, abdominal pain, and dehydration.

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