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Pediatric Puzzler

Reticulated rash on boy’s lower extremities

Feb 1, 2019
  • Ayush R Joshi, MD
  • Natalia Golova, MD, FAAP
  • Chandan Lakhiani, MD, FAAP

A healthy 11-year-old boy is brought to the office for evaluation of asymptomatic reticulated rash that started on his ankles 3 weeks ago and since has spread to his shins and the tops of both feet. He is on no medications and has had no history of trauma or recent illness. What's the diagnosis?

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Child with a history of multiple fractures

Feb 1, 2019
  • Ankur K Shah, MD, PhD
  • Emily C King, MD, MS
  • Lynda E Polgreen, MD, MS
  • Catherine S Mao, MD
  • Jennifer K Yee, MD

The patient, an 8-year-old male who recently immigrated to the United States from El Salvador, initially presented to the emergency department (ED) for a cough. The next day, he went to the general pediatrics clinic for follow-up and was noted to have a significant history of recurrent fractures.

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Left lower quadrant abdominal pain, vomiting

Jan 1, 2019
  • Sarah S Cole, MD, MAJ, USA, MC

A 4-year-old girl presents to the emergency department (ED) with a 12-hour history of progressively worsening episodic left lower quadrant (LLQ) abdominal pain and nonbilious emesis. There was no history of fever, diarrhea, hematochezia, constipation, or dysuria. The child was previously healthy, did not take any medications, and had no history of prior surgery.

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Streaky pigmentation suggests larger issues

Jan 1, 2019
  • Aaron Samide, MD
  • Melissa Brinn, MD, FAAP
  • Taryn Anne Hill, MD, MED, FAAP

The parents of a 2-month-old boy return to the office for a well-child visit. The infant has a history of hypotonia and poor head control but is growing normally. His parents noted streaky patterns of hypopigmentation over his trunk and extremities shortly after birth and felt they were likely just “birthmarks.”

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Infant resists moving right shoulder or elbow

Dec 1, 2018
  • Gena Schubert, D.O.
  • Gabrielle Karpinsky, MD
  • Melissa February, MD

An 11-day-old, full-term male presents to the emergency department (ED) with a 2-day history of decreased range of motion of his right upper extremity.

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Girl’s hands shrivel when exposed to water

Dec 1, 2018
  • Amy H Huang, BA, MS4
  • Bernard Cohen, MD

A 16-year-old girl presents to the clinic for acne follow-up and mentions that her palms wrinkle significantly after only a few minutes of immersion in water. She is otherwise well and has no significant past medical history.

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Chronic cough in a 4-year-old boy

Nov 1, 2018
  • Jeffrey Ni, BS, MS4
  • Bridget Boyd, MD

A previously healthy 4-year-old male, born late preterm by urgent cesarean delivery with an uncomplicated postnatal course, presents to the outpatient clinic for a chief complaint of worsening cough over the past 5 months. He denies current fever, rhinorrhea, shortness of breath, diarrhea, or vomiting. His cough has been worsening in severity and frequency, and mostly occurs during the daytime.

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Persistent pruritic rash in an 8-year-old boy

Nov 1, 2018
  • Julie H Wu, BA, MS4
  • Bernard Cohen, MD

An 8-year-old boy is brought to the office for evaluation of a persistent itchy rash on his extremities, trunk, and face. Although the rash has been present for longer than 3 months, individual skin lesions change from hour to hour and occasionally the rash clears completely only to recur several hours later. He is otherwise healthy with no known allergies, changes in diet, medication use, or recent illness.

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Boy’s progressive extremity rash looks fishy

Oct 1, 2018
  • Laura Livaditis, MD

A previously healthy 8-year-old boy presents to the dermatology clinic with a progressively worsening elbow rash over the course of the last week. The rash does not itch. He spent the previous weekend sailing on the Chesapeake Bay. His pediatrician prescribed a course of cephalexin as well as a trial of topical antiviral ointment, neither of which improved the rash. The patient denies any other new exposures. 

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Teenager suffers diarrhea, emesis, and weight loss

Oct 1, 2018
  • Alexandra J Mihalek, MD
  • Katherine W Canty, MD
  • Miriam Chan, MD
  • Melinda Braskett, MD
  • Vrinda Bhardwaj, MD, FAAP
  • Kira A Molas-Torreblanca, DO

A 16-year-old male with a history of nephrotic syndrome and gastritis presents to the emergency department (ED) with worsening emesis, diarrhea, and abdominal pain of 3-weeks’ duration.

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ADHD in Children

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Vol 36 No 2
Feb 05, 2019 Vol 36 No 2
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